Prolonged Prophylaxis of Thromboembolic Disease in Patients with Colorectal Surgical Resections for Malignancy

Authors: R. Brzežková;  V. Frýba *;  K. Chrz *;  Z. Krška *;  J. Kvasnička
Authors‘ workplace: Trombotické centrum a Centrální hematologické laboratoře, Ústav klinické biochemie a laboratorní diagnostiky ;  I. chirurgická klinika, Všeobecná fakultní nemocnice a 1. LF UK v Praze *
Published in: Rozhl. Chir., 2009, roč. 88, č. 11, s. 642-648.
Category: Monothematic special - Original


Cancer patients have 6-fold higher risk of venous thromboembolism compared with patients without malignancy. This risk of VTE is further increased by cancer surgery.

Aim of the study:
The aim of our pilot study was to examine the changes in inflammatory reaction, changes of coagulation parameters and inhibition of FXa in patients with new diagnosed colorectal cancer. During 30 days of observation prophylactic dose of dalteparin 5000 UI subcutaneously once daily was administrated.

Patients and methods:
Patients who underwent surgical resection of the colon for new diagnosed colorectal cancer were included in the study.

Laboratory tests (blood count, acute phase proteins – alpfa-1-antitrypsin, transferin, prealbumin, alpfa-2-makroglobulin, orosomukoid and C reactive protein and coagulation laboratory tests – PT in INR, aPTT, TT, fibrinogen concentration, activity of antithrombinu and concentration of D-dimer) were performed before surgery and on day 3, 10 and 30 after surgery.

Inflammatory response reached highest level on day 3, lasted until day 10 after surgery than parameters returned to normal values (p < 0.05). Hypercoagulable tendency was already seen before surgery, highest value of D-dimer was measured on day 10 after surgery and after decrease it lasted until the day 30 after surgery (p < 0.05).

Inhibition of FXa varied between 0.02–0.7 IU/ml. The prophylactic range of FXa inhibition 0.2–0.4 IU/ml was reached in 48.1% of the samples, 20.4 % of the samples were over the range and 31.5 % were under the prophylactic range.

During 30 day of observation deep vein thrombosis was not detected in any patient as well as bleeding complication.

The pilot study shows that prolonged prophylaxis of VTE is advisable in patients after cancer surgery. Variation of FXa inhibition will be in our study further examined.

Key words:
colorectal cancer – colorectal resection – venous thromboembolism – low-molecular-weight heparins


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