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Pulmonary Vascular Disease |

Fondaparinux Versus Low Molecular Weight Heparin Following Esophagectomy: Results From a Randomized and Controlled Trial

Yaxing Shen, MD; Ming Zhong, MD; Lijie Tan, MD
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Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China


Chest. 2014;145(3_MeetingAbstracts):535D. doi:10.1378/chest.1921851
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Abstract

SESSION TITLE: Late Breaking Abstracts

SESSION TYPE: Slide Presentation

PRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AM

PURPOSE: Venous thromboembolism (VTE) remained common following surgical resection of esophageal cancer. In this prospective randomized controlled trial (NCT01267305), we aim to compare the safety and efficacy between two anticoagulants applied in the prophylaxis of VTE following esophagectomy.

METHODS: During January 2011 to July 2012, patients underwent esophagectomy were randomly assigned to daily Nadroparin Calcium (4100Axa IU, Group H), or fondaparinux (2.5mg, Group F) in the prophylaxis of VTE. All patients received thrombelastography (TEG) before and 24/48/72 hours after operation. Daily vascular ultrasound of lower extremities was followed to confirm the suspected deep venous thrombosis (DVT), and post-operative chest drainage was collected and compared to identify the difference between the two groups.

RESULTS: A total of 121 patients were enrolled in this study, and 116 eligible patients were randomly assigned (Group H: 57 patients; Group F: 59 patients). Patients' clinical features were close in between the two groups. TEG analysis showed nearly identical results, except for longer K time (3.17±1.79s versus 1.96±0.81s, p=0.015) and lower CI (-1.88±4.36 versus1.06±2.80, p=0.025) recorded in Group F at 48 hours post-operatively. In ultrasound follow-ups, a total of eight cases of DVT (3 cases in Group F and 5 cases in Group H) were found in this cohort, and one case of pulmonary embolism (in Group H) was observed. The incidence of VTE was close between the two groups (7.02% versus 8.47%, p=0.957). At 72 hours after surgery, the volume of chest drainage collected from Group F was higher than in Group H (224.32±116.52 ml versus 139.75±76.68 ml, p=0.018). No patient died due to VTE or bleeding.

CONCLUSIONS: In the prophylaxis of VTE, daily fondaparinux provided equal efficacy when compared to low molecular weight heparin, while it may increase risks of bleeding following the operation. Further study based on larger population is required to confirm these findings.

CLINICAL IMPLICATIONS: Fondaparinux would be an efficient anticoagulant in the prophylaxis of VTE following esophagectomy, while increased risk of bleeding due to its application should be noticed.

DISCLOSURE: The following authors have nothing to disclose: Yaxing Shen, Ming Zhong, Lijie Tan

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