The following is the summary of “Should all patients receive extended thromboprophylaxis after resection of primary lung cancer?” published in the December 2022 issue of Thoracic and cardiovascular surgery by Kho, et al.

No consensus exists on how long patients should take thromboprophylaxis before and after surgery for primary lung cancer. Researchers analyzed the effects of switching from short- to long-term thromboprophylaxis on the rate of pulmonary embolisms and venous thromboembolisms in patients undergoing resection for early-stage lung cancer. In addition, investigators looked at the results of a protocol shift from inpatient-only to extended thromboprophylaxis to 28 days for patients with early-stage primary lung cancer who underwent resection. Both the standard inpatient pharmacologic thromboprophylaxis group and the extended pharmacologic thromboprophylaxis group were matched using propensity scores. 

Covariate adjustments were made using the Caprini model of risk evaluation. The results of the 2 groups’ thromboembolic risk factors were compared. Between January 2013 and December 2018, 750 individuals with primary lung cancer underwent resection at Oxford University Hospitals NHS Foundation Trust. There were 600 patients used in the analysis, and 253 matched pairings were found using propensity scores. Pulmonary emboli were significantly reduced with prolonged prophylaxis (10 of 253 patients [4%] vs 1 of 253 patients [0.4%], P=.01). One person in the therapy group experienced a bleeding problem. 

The risk of postoperative pulmonary embolism was found to be lower among patients who had prolonged thromboprophylaxis, as determined by a multivariate logistic regression analysis. It is estimated that between 15 and 30% of patients undergoing surgery to remove lung cancer would develop a thromboembolic illness in the days and weeks following the procedure. In patients undergoing excision of early-stage primary lung cancer, extended dalteparin for 28 days is safe and is related with a decreased incidence of pulmonary embolism.