Efficacy and safety of extended duration to perioperative thromboprophylaxis with low molecular weight heparin on disease-free survival after surgical resection of colorectal cancer (PERIOP-01): multicentre, open label, randomised controlled trial

• Published in: BMJ (Online) Vol. 378; p. e071375
• Main Authors: Auer, Rebecca C, Ott, Michael, Karanicolas, Paul, Brackstone, Muriel Rebecca, Ashamalla, Shady, Weaver, Joel, Tagalakis, Vicky, Boutros, Marylise, Stotland, Peter, Marulanda, Antonio Caycedo, Moloo, Husein, Jayaraman, Shiva, Patel, Suni, Le Gal, Grégoire, Spadafora, Silvana, MacLellan, Steven, Trottier, Daniel, Jonker, Derek, Asmis, Timothy, Mallick, Ranjeeta, Pecarskie, Amanda, Ramsay, Tim, Carrier, Marc, Tadros, Shaheer, Raiche, Isabelle, Williams, Lara, Musselman, Reilly, Nessim, Carolyn, Fenech, Darlene, Zweip, Terry, Parry, Niel, Gray, Daryl, Leslie, Ken, Vasilevsky, Carol-Ann, Ghitelescu, Gabriela, Faria, Julio, MacDonald, Hugh
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 13.09.2022; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Subjects: Adenocarcinoma; Anticoagulants; Bleeding; Cancer therapies; Colorectal cancer; Colorectal carcinoma; Hemoglobin; Heparin; Invasiveness; Metastases; Metastasis; Molecular weight; Patients; Pulmonary embolisms; Surgery; Survival; Thrombocytopenia; Thromboembolism; Thrombosis; Veins & arteries
• ISSN: 1756-1833; 0959-8138; 1756-1833
• DOI: 10.1136/bmj-2022-071375

AbstractObjectiveTo determine the efficacy and safety of extended duration perioperative thromboprophylaxis by low molecular weight heparin when assessing disease-free survival in patients undergoing resection for colorectal cancer.DesignMulticentre, open label, randomised controlled trial.Settings12 hospitals in Quebec and Ontario, Canada, between 25 October 2011 and 31 December 2020.Participants614 adults (age ≥18 years) were eligible with pathologically confirmed invasive adenocarcinoma of the colon or rectum, no evidence of metastatic disease, a haemoglobin concentration of ≥8 g/dL, and were scheduled to undergo surgical resection.InterventionsRandom assignment to extended duration thromboprophylaxis using daily subcutaneous tinzaparin at 4500 IU, beginning at decision to operate and continuing for 56 days postoperatively, compared with in-patient postoperative thromboprophylaxis only.Main outcome measuresPrimary outcome was disease-free survival at three years, defined as survival without locoregional recurrence, distant metastases, second primary (same cancer), second primary (other cancer), or death. Secondary outcomes included venous thromboembolism, postoperative major bleeding complications, and five year overall survival. Analyses were done in the intention-to-treat population.ResultsThe trial stopped recruitment prematurely after the interim analysis for futility. The primary outcome occurred in 235 (77%) of 307 patients in the extended duration group and in 243 (79%) of 307 patients in the in-hospital thromboprophylaxis group (hazard ratio 1.1, 95% confidence interval 0.90 to 1.33; P=0.4). Postoperative venous thromboembolism occurred in five patients (2%) in the extended duration group and in four patients (1%) in the in-hospital thromboprophylaxis group (P=0.8). Major surgery related bleeding in the first postoperative week was reported in one person (<1%) in the extended duration and in six people (2%) in the in-hospital thromboprophylaxis group (P=0.1). No difference was noted for overall survival at five years in 272 (89%) patients in the extended duration group and 280 (91%) patients in the in-hospital thromboprophylaxis group (hazard ratio 1.12; 95% confidence interval 0.72 to 1.76; P=0.1).ConclusionsExtended duration to perioperative anticoagulation with tinzaparin did not improve disease-free survival or overall survival in patients with colorectal cancer undergoing surgical resection compared with in-patient postoperative thromboprophylaxis alone. The incidences of venous thromboembolism and postoperative major bleeding were low and similar between groups.Trial registrationClinicalTrials.gov NCT01455831.