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Multicenter Study
. 2024 Jul;44(7):549-557.
doi: 10.1002/phar.2945. Epub 2024 Jun 17.

Enhancing thromboprophylaxis after colorectal cancer surgery in China: Bridging the gap between evidence and implementation through pathway optimization

Zhi-Chun Gu  1   2   3 , Meng-Fei Dai  4 , Qi Wei  5 , Yi-Dan Yan  2   3 , Jian-Yong Zheng  6 , Gui-Ying Wang  7 , Zheng-Qiang Wei  8 , Chang-Qing Jing  9 , Yong-Xiang Li  10 , Dong-Bing Zhou  11 , Mou-Bin Lin  12 , Xian-Li He  13 , Fan Li  14 , Qian Liu  15 , Shi-Liang Tu  16 , Zhen-Jun Wang  17 , Ang Li  18 , Hou-Wen Lin  1   2   3 , Hong-Wei Yao  5 , Zhong-Tao Zhang  5 ; CRC‐VTE Investigators
Affiliations
Multicenter Study

Enhancing thromboprophylaxis after colorectal cancer surgery in China: Bridging the gap between evidence and implementation through pathway optimization

Zhi-Chun Gu et al. Pharmacotherapy. 2024 Jul.

Abstract

Background: The CRC-VTE trial conducted in China revealed a significant occurrence of venous thromboembolism (VTE) in patients following colorectal cancer (CRC) surgery, raising concerns about implementing thromboprophylaxis measures. The present study aimed to identify and analyze inappropriate aspects of current thromboprophylaxis practices.

Methods: This study performed an analysis of the CRC-VTE trial, a prospective multicenter study that enrolled 1836 patients who underwent CRC surgery. The primary objective was to identify independent risk factors for VTE after CRC surgery using multivariate logistic regression analysis. Furthermore, among the cases in which VTE occurred, the appropriateness of thromboprophylaxis was assessed based on several factors, including pharmacologic prophylaxis, time to initiate prophylaxis, drug selection, drug dosage, and duration of pharmacologic prophylaxis. Based on the analysis of the current state of thromboprophylaxis and relevant clinical guidelines, a modified Delphi method was used to develop a clinical pathway for VTE prophylaxis after CRC surgery.

Results: In this analysis of 1836 patients, 205 (11.2%) were diagnosed with VTE during follow-up. The multifactorial analysis identified several independent risk factors for VTE, including age (≥70 years), female sex, varicose veins in the lower extremities, intraoperative blood transfusion, and the duration of immobilization exceeding 24 h. None of the patients diagnosed with VTE in the CRC trial received adequate thromboprophylaxis. The main reasons for this inappropriate practice were the omission of thromboprophylaxis, delayed initiation, and insufficient duration of thromboprophylaxis. We developed a specialized clinical pathway for thromboprophylaxis after CRC surgery to address these issues.

Conclusions: This study offers a comprehensive nationwide evaluation of existing thromboprophylaxis practices in patients after CRC surgery in China. A specialized clinical pathway was developed to address the identified gaps and improve the quality of care. This clinical pathway incorporates explicit, tailored, detailed recommendations for thromboprophylaxis after CRC surgery.

Keywords: appropriate thromboprophylaxis; clinical pathway; colorectal cancer; venous thromboembolism.

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References

REFERENCES

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