Perioperative DVT Prophylaxis

The survey for the Thoracic Portal addressed an important topic in the management of non-small cell lung cancer. Patients with NSCLC are at increased risk for perioperative deep venous thrombosis. The results of this survey will help inform the practicing surgeon about how other surgeons manage this challenging clinical situation.

The questions related to a 63-year-old male with a peripheral T1 RUL NSCLC who was in otherwise good health. He had adequate cardiopulmonary function to permit lobectomy. Almost 90% of respondents provide DVT prophylaxis routinely for such a patient, although only 60% use systemic anticoagulants and only a third use mechanical devices for the lower extremities. These findings are not in keeping with current recommendations for prophylactic measures against DVT for cancer patients undergoing major surgery, which indicate that systemic and mechanical means should both be used.

The observed incidence of lower extremity DVT is low, with more than 90% of respondents indicating that fewer than 5% of their patients are so affected. This likely accounts for the relatively high threshold for using PE protocol CT scans to evaluate for pulmonary embolism when symptoms develop.

1. Under what circumstances do you provide DVT prophylaxis?
		Response Percent	Response Count
Only when there is evidence for distant prior DVT		2.4%	4
Only when there is evidence for recent prior DVT		5.5%	9
Routinely		89.0%	146
Never		3.0%	5
	answered question		164
	skipped question		1

2. What DVT prophylaxis do you use routinely? Please check all that are appropriate in your practice
		Response Percent	Response Count
Perioperative low dose heparin		61.6%	101
Perioperative lower extremity sequential compression devices		31.7%	52
Temporary IVC filter		0.0%	0
Prophylactic anticoagulation after discharge		2.4%	4
None		4.3%	7
	answered question		164
	skipped question		1

3. What is your incidence of lower extremity DVT in the early postoperative period after major lung resection?
		Response Percent	Response Count
<5%		92.5%	149
5%-10%		6.2%	10
10%-15%		0.6%	1
>15%		0.6%	1
	answered question		161
	skipped question		4

4. In a patient who is diagnosed with lower extremity DVT in the early postoperative period, what is the indication for a PE protocol CT scan?
		Response Percent	Response Count
Only when respiratory symptoms arise		52.4%	86
When chest pain or arrhythmia occur		17.1%	28
Routinely regardless of symptoms		21.3%	35
We don't perform PE protocol CT scans		9.1%	15
	answered question		164
	skipped question		1

5. In what region do you work?
		Response Percent	Response Count
North America		51.2%	84
Europe		32.3%	53
South America		2.4%	4
Asia		11.6%	19
Africa		2.4%	4
	answered question		164
	skipped question		1