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The Annals of Thoracic Surgery, Vol 56, 223-226, Copyright © 1993 by The Society of Thoracic Surgeons
S Ziomek, RC Read, HG Tobler, JE Harrell Jr, JC Gocio, LM Fink, TJ Ranval, EJ Ferris, DL Harshfield and DR McFarland
To determine the incidence of thromboembolism in relation to thoracotomy,
77 patients undergoing pulmonary resection were prospectively studied up to
30 days postoperatively for deep venous thrombosis and pulmonary embolism.
Overall, 20 of 77 patients (26%) had thromboembolic events during their
hospitalization. Four deep venous thromboses and 1 pulmonary embolism were
detected in 5 of 77 patients preoperatively for an incidence of 6%.
Postoperative thromboembolism was detected in 15 of 77 (19%): deep venous
thrombosis in 11 (14%) and pulmonary embolism in 4 (5%). No postoperative
thromboembolisms occurred in the 17 patients receiving preoperative aspirin
or ibuprofen, whereas they did occur in 25% of the remainder (15/60).
Thromboembolism after pulmonary resection was more frequent with
bronchogenic carcinoma than with metastatic cancer or benign disease (15/59
[25%] versus 0/18 [0%]; p < 0.01), adenocarcinoma compared with other
types of carcinoma (11/25 [44%] versus 4/34 [12%]; p < 0.0004), large
primary lung cancer (> 3 cm in diameter) compared with smaller lesions
(9/19 [47%] versus 6/40 [15%]; p < 0.0001), stage II compared with stage
I (7/14 [50%] versus 7/34 [21%]; p < 0.04), and pneumonectomy or
lobectomy compared with segmentectomy and wedge resection (14/49 [29%]
versus 1/28 [4%]; p < 0.005). Three of 4 patients with thromboembolism
detected preoperatively had operation within the previous year.
Postoperative pulmonary embolism was fatal in 1 of 4 (25%) and accounted
for the one death. These results suggest patients undergoing thoracotomy
for lung cancer, especially adenocarcinoma, should be considered for
thromboembolic prophylaxis.
ARTICLES
Thromboembolism in patients undergoing thoracotomy
McClellan Memorial Veterans' Hospital, Little Rock, AR 72205.
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