New results from a research project at Boston University School of Medicine suggest that a model currently used to assess the risk of venous thromboembolism, a disease that includes both deep vein thrombosis and pulmonary embolism, is useful at stratifying risk in lung cancer patients submitted to lung resection.
The research team led by Virginia R. Litle, MD, associate professor of surgery at Boston University School of Medicine analyzed data from 232 patients who underwent lung resection. They used the Caprini risk assessment model to categorize patients according to their risk to suffer venous thromboembolism. The model includes 42 risk factors categorized in different levels of risk, including low-to-moderate (less than four risk factors), high (5-8 risk factors) and highest (more than nine risk factors).
Within 60 days of lung surgery, 12 patients developed venous thromboembolism, and 6 of those specifically pulmonary embolisms. Patients with venous thromboembolism were scored the highest in the Caprini model, when compared with patients that remained free of venous thromboembolism. The team observed a 0% incidence of venous thromboembolism in the low-to-moderate score group, a 1.67% in the high score group and 10.42% in the highest score group. Patients who underwent open thoracotomy exhibited 90% of positive cases of venous thromboembolism. The minimally invasive video-assisted thoracoscopic surgery posed no increased risk for venous thromboembolism at this time, and the research team suggested it should not be included into the Caprini model until determined in a larger sample study.
Virginia R. Litle, MD, commented “The Caprini risk assessment model is used as a VTE risk assessment tool in other surgical specialties, including general, vascular and plastic surgery, as well as gynecologic oncology. In abdominal and pelvic cancer patients, the [risk assessment model] helps physicians evaluate extended prophylactic use of blood thinners, but it has not been applied in thoracic surgery. This risk assessment scoring system can be used to determine which lung resection patients may potentially benefit from preventive blood thinner therapy after discharge. We have measured these scores and found that a prolonged course of enoxaparin sodium (Lovenox, Sanofi-Aventis) or other blood thinners may improve the risk of dying of this complication after a lung cancer operation.”