Extended Out-of-hospital Low-molecular-weight Heparin Prophylaxis Against DVT and PE in Patients Undergoing Major Lung Resection

Postoperative venous thromboembolism (VTE) is a significant health-care problem, resulting in significant morbidity, mortality and resource utilization. The true incidence is unknown, and may range from 1% to 15%. At the current time, the clinical practice of VTE prophylaxis in thoracic surgery includes administration of unfractionated or low molecular weight heparin starting at the perioperative period and finishing at the time of patients' discharge. In orthopaedic surgery, prolonged thromboprophylaxis beyond 10 days and up to 35 days has become the standard of care. There is a clear need to systematically evaluate the incidence of VTE after resection of lung malignancies and to evaluate the role of extended VTE prophylaxis in preventing Deep Vein Thrombosis (DVT) and pulmonary embolus (PE) after those major lung resections. This study will involve patients undergoing lung resection for malignancy at St. Joseph's Healthcare Hamilton and the University Health Network's Toronto General Hospital. The study will include 150 consecutively recruited patients. Study interventions will include Computed Tomography with pulmonary embolus (PE) protocol and bilateral extended leg Doppler Ultrasound for the detection of Deep Vein Thrombosis 30 days post-surgery. In summary, this study is aimed at evaluating, for the first time in a prospective manner, the actual incidence of DVT and PE in patients undergoing major lung resections for malignancies. The knowledge gained in this study will be used to inform a future investigation involving a Randomized Controlled Trial (RCT) to compare current post-operative thromboprophylaxis with an extended 30-day prophylaxis protocol with the hope of providing an evidence-based practice change in VTE prophylaxis care for this high risk population.

Sex

All

Minimum age

18 Years

Patient Inclusion Criteria

* At least 18 years of age
* Either gender
* Diagnosed with resectable lung cancer or metastatic lung disease eligible to complete metastasectomy
* Undergoing one of the following surgeries: Segmentectomy, wedge resection, lobectomy, bilobectomy or pneumonectomy
* Competent to understand and sign consent documents

Patient Exclusion Criteria

* Known allergic or anaphylactic reaction to contrast dye, heparin or low molecular weight heparin (LMWH)
* Under current anticoagulation for venous thromboembolism or other medical conditions
* Known renal impairment, defined as creatinine clearance value of less than 55ml/min/m2 as calculated by the Cockroft-Gault method
* History of, or ongoing liver disease, manifested as ascites or previous peritoneal tapping for ascites
* Pregnant or planning to become pregnant
* Diagnosed or treated for VTE in the past 3 months prior to surgery
* Present or previous increase risk of haemorrhage
* History of previous HIT (heparin induced thrombocytopenia)
* Platelet count must be below 75,000
* Previously inserted Inferior Vena Cava Filter (IVC) filter.

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