Preoperative Chemoprophylaxis Is Safe in Major Oncology Operations and Effective at Preventing Venous Thromboembolism

BACKGROUND: We prospectively evaluated the safety and efficacy of adding pre-operative chemoprophylaxis to our institution’s operative venous thromboembolism (VTE) prophylaxis policy as part of a physician led quality improvement initiative. STUDY DESIGN: Patients undergoing major cancer surgery between August 2013 and January 2014 were screened according to service-specific eligibility criteria and targeted to receive pre-operative VTE chemoprophylaxis. Bleeding, transfusion, and VTE rates were compared to historical controls who had not received pre-operative chemoprophylaxis. RESULTS: The 2,058 eligible patients who underwent operation between August 2013 and January 2014 (post-intervention) were compared to a cohort of 4,960 patients operated on between January 2012 and June 2013 that did not receive pre-operative VTE chemoprophylaxis (pre-intervention). In total, 71% of patients in the post-intervention group were screened for eligibility; 82% received pre-operative anticoagulation. When compared to the pre-intervention group, the post-intervention group had significantly lower transfusion rates (pre vs. post-intervention, 17% vs 14%; difference 3.5%, 95% CI: 1.7% – 5%, p=0.0003) without significant difference in major bleeding (difference 0.3%, 95% CI: −0.1% – 0.7%, p=0.2). Rates of deep venous thrombosis (1.3% vs 0.2%; difference 1.1%, 95% CI: 0.7% – 1.4%, p <0.0001) and pulmonary embolus (1.0% vs 0.4%; difference 0.6%, 95% CI: 0.2% – 1%, p=0.017) were significantly lower in the post-intervention group CONCLUSIONS: In patients undergoing major cancer surgery, institution of a single dose of pre-operative chemoprophylaxis, as part of a physician led quality improvement initiative, did not increase bleeding or blood transfusions and was associated with a significant decrease in VTE rates