To evaluate the efficacy and the safety of the prophylaxis of perioperative venous thromboembolism (VTE) in thoracic surgery by comparing the incidence of VTE between patients who have taken anticoagulation measures and those who haven’t.

Retrospective research was conducted on patients who underwent lung surgeries in Beijing Chaoyang Hospital from July 2016 to December 2017. The patients were divided into an anticoagulant group in which the patients received preventative anticoagulant measures during the hospitalization, and a control group, in which the patients didn’t. Because of the great bundle of confounding bias between the two groups, propensity score matching (PSM) was used as a way to minimize the influence of such bias. One hundred and eight pairs of patients were successfully matched by the ratio of 1:1 with the caliper set to 0.2. The difference in VTE incidence, hemorrhage event incidence, thoracic drainage, hospitalization length and total fare were compared between the two groups, so that the efficacy and the safety of the preventative prophylaxis of perioperative venous thromboembolism could be evaluated.

A total of 645 patients were enrolled in the study, 22.0% of which (142/645) received preventative perioperative anticoagulant. Modified Caprini risk score was applied to evaluate the VTE risk, ≤4 is low risk, 5-8 medium risk, ≥9 high risk. The percentage of patients who received anticoagulant measures was 6.6% (12/182) in low Caprini risk patients, 26.8% (117/436) in medium Caprini risk patients, 48.1% (13/27) in high Caprini risk patients. Of which 48.6% (69/142) of the patients received anticoagulant measures for only 1-3 days before discharge, 33.1% (47/142) for 4-6 days, and 18.3% for more than 7 days. After PSM matching, 108 pairs of patients were successfully matched by the ratio of 1:1: 8.3% (9/108) in the anticoagulation group developed VTE postoperatively, while 17.6% (19/108) in the non-anticoagulation group (χ²=4.103, P<0.05). Among medium Caprini risk patients, 7.8% (7/90) of anticoagulation group patients developed VTE while 17.6% (16/91) for non-anticoagulation group (χ²=3.921, P<0.05) . There was no significant difference in VTE incidence of low Caprini risk or high Caprini risk patients between the two groups. In malignant tumor patients, there was no significant difference in VTE incidence between the two groups (9.4% vs 19.1%, P=0.060) . In benign disease patients, there was no significant difference in VTE incidence between the two groups (4.3% vs 10.5%, P=0.599) . No postoperative hemorrhage event was observed in all the patients. And there was no significant difference between patients who took anticoagulation preoperatively and patients who didn’t take in items of operation time and operation hemorrhage (P>0.05) . No significant difference in postoperative D-dimer level, thoracic drainage, length of postoperative hospitalization and total fare was observed between patients who took anticoagulation perioperatively and patients who didn’t (P>0.05) .

Perioperative anticoagulation can reduce the incidence of VTE in patients who take lung surgeries. Medium Caprini risk patients can benefit from it especially. And perioperative anticoagulation doesn’t increase the operation risk preoperatively or postoperatively. More patients with VTE risks should be considered to receive anticoagulation measures respectively according to their VTE risk level calculated by Caprini risk scale.