Objective  To explore the preventive effect of low molecular weight heparin (LMWH) combined with integrated medical-nursing enhanced recovery after surgery (ERAS) intervention on postoperative deep vein thrombosis (DVT) in colorectal cancer (CRC) patients.

Methods  A retrospective collection of postoperative CRC patients at Hangzhou Hospital of Traditional Chinese Medicine from January 2021 to October 2023 was conducted. Patients were divided in the combined intervention group (LMWH combined with ERAS) and the control group (LMWH) based on the intervention methods. The primary observation indicators of this study was the incidence of lower extremity DVT. Secondary observation indicators included changes in coagulation parameters [D-dimer (D-D), thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (Fib)] before and after intervention; blood flow velocity in the bilateral popliteal, external iliac, and femoral veins; time to first postoperative anal gas passage, time to resume eating, time to get out of bed and length of hospital stay; postoperative complication rate and adverse drug reaction rate.

Results  A total of 110 patients were included in the study, with 55 in the combined intervention group and 55 in the control group. There were no statistically significant differences between the two groups in terms of baseline characteristics, coagulation-related indicators before intervention, and lower limb venous blood flow velocity (P>0.05). After 7 and 14 days of intervention, TT, PT, APTT, and Fib levels in both groups were higher compared to before the intervention, while D-D levels decreased (P<0.05). There were no significant differences in TT, PT, and APTT between the two groups (P>0.05), but the D-D level in the combined intervention group was lower than that in the control group (P<0.05), and the Fib level was higher than that in the control group (P<0.05). After 14 days of intervention, the blood flow velocities in the bilateral popliteal, external iliac, and femoral veins were higher in the combined intervention group than in the control group (P<0.05), and the incidence of DVT was lower (1.82% vs. 7.27%), but the difference was not statistically significant (P=0.363). The combined intervention group had shorter postoperative time to first anal gas passage, resumption of eating, getting out of bed, and length of hospital stay compared to the control group (P<0.05). Finally, there were no statistically significant differences between the two groups in the incidence of postoperative complications and adverse reactions to LMWH (P>0.05).

Conclusion  The combined intervention of LMWH and ERAS can effectively improve the hypercoagulable state in postoperative CRC patients, increase the venous blood flow velocity in the lower limbs, reduce the incidence of DVT, promote postoperative recovery, and has good safety.

1.Siegel RL, Miller KD, Fuchs HE, et al. Cancer Statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1): 7-33. DOI: 10.3322/caac.21654.

2.ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to the global disease burden[J]. J Thromb Haemost, 2014, 12(10): 1580-1590. DOI: 10.1111/jth.12698.

3.Bergqvist D. Venous thromboembolism: a review of risk and prevention in colorectal surgery patients[J]. Dis Colon Rectum, 2006, 49(10): 1620-1628. DOI: 10.1007/s10350-006-0693-0.

4.Wei Q, Wei ZQ, Jing CQ, et al. Incidence, prevention, risk factors, and prediction of venous thromboembolism in Chinese patients after colorectal cancer surgery: a prospective, multicenter cohort study[J]. Int J Surg, 2023,109(10):3003-3012. DOI: 10.1097/JS9. 0000000000000553.

5.姚书婷, 鄢金柱, 柯玉芳, 等. 低分子肝素联合物理治疗预防妇科肿瘤术后下肢深静脉血栓形成的网状Meta分析[J]. 医学新知, 2022, 32(2): 108-119. [Yao ST, Yan JZ, Ke YF, et al. Low molecular weight heparin plus physiotherapy techniques in prevention of deep vein thrombosis in gynecological cancer patients undergoing major abdominopelvic surgery: a network Meta-analysis[J]. Yixue Xinzhi Zazhi, 2022, 32(2): 108-119.] DOI: 10.12173/j.issn.1004-5511.202109007.

6.Sakon M, Kobayashi T, Shimazui T. Efficacy and safety of enoxaparin in Japanese patients undergoing curative abdominal or pelvic cancer surgery: results from a multicenter, randomized, open-label study[J]. Thromb Res, 2010, 125(3): e65-e70. DOI: 10.1016/j.thromres.2009.09.009.

7.唐雪, 杜元晨, 陈志文, 等.磺达肝癸钠与低分子肝素在连续性肾脏替代治疗中的抗凝效果评价 [J].华西医学, 2023, 38(1): 51-55. [Tang X, Du YC, Chen ZW, et al. Evaluation of anticoagulant effects of sodium heparin glycyrrhetate and low molecular weight heparin in continuous renal replacement therapy [J]. West China Medical Journal, 2023, 38(1): 51-55.] DOI: 10.7507/1002-0179.202206019.

8.陈思娇, 邬文君, 郑雅文. 术前口服复合益生菌对结直肠癌根治术后感染性并发症的预防作用[J]. 中国药师, 2023, 26(10): 119-124. [Chen SJ, Wu WJ, Zheng YW. The preventive effect of preoperative oral administration of compound probiotics on infectious complications after radical surgery for colorectal cancer[J]. Chinese Pharmacist, 2023, 26(10): 119-124.] DOI: 10.12173/j.issn.1008-049X.202310029.

9.杨柳, 王亚利, 郑良霞, 等. 基于医护一体化的教育与管理提高支气管哮喘控制: 一项真实世界的前瞻性队列研究[J]. 中国循证医学杂志, 2022, 22(2): 140-147. [Yang L, Wang YL, Zheng LX, et al. Education and management based on integrated medical care improve control of bronchial asthma: a real-world prospective cohort study[J]. Chinese Journal of Evidence-Based Medicine, 2022, 22(2): 140-147.] DOI: 10.7507/1672-2531.202109013.

10.王海燕, 王丽, 朱碧丽, 等. 快速康复外科在肾上腺手术围术期患者中有效性和安全性的Meta分析[J]. 中国循证医学杂志, 2019, 19(10): 1211-1216. [Wang HY, Wang L, Zhu BL, et al. Meta-analysis of the effectiveness and safety of fast-track surgery in patients undergoing adrenal surgery in the perioperative period[J]. Chinese Journal of Evidence-Based Medicine, 2019, 19(10): 1211-1216.] DOI: 10.7507/1672-2531.201904010.

11.葛莉娜, 李梦娜, 刘晓夏, 等. 医护一体化管理结合快速康复外科在卵巢癌患者中的应用效果[J]. 中国医科大学学报, 2023, 52(9): 855-859. [Ge LN, Li MN, Liu XX, et al. The application effect of integrated medical and nursing management combined with fast-track Surgery in ovarian cancer patients[J]. Journal of China Medical University, 2023, 52(9): 855-859.] DOI: 10.12007/j.issn.0258-4646.2023.09.015.

12.高巧娜. 医护一体化快速康复外科理念指导下针对性干预在结直肠癌患者围术期的初步应用[J]. 河南外科学杂志, 2021, 27(5): 187-189. [Gao QN. Preliminary application of targeted intervention in the perioperative period of colorectal cancer patients cuided by the concept of integrated care fast track surgery[J]. Henan Journal of Surgery, 2021, 27(5): 187-189.] DOI: 10.16193/j.cnki.hnwk.2021.05.086.

13.李智, 徐禹, 汪晓东, 等. 快速康复外科在大肠癌患者应用中的焦虑心理及护理研究进展[J].华西医学, 2013, 28(8): 1315-1318. [Li Z, Xu Y, Wang XD, et al. Research progress on anxiety psychology and nursing in the application of fast-track surgery in patients with colorectal cancer [J]. West China Medical Journal, 2013, 28(8): 1315-1318.] DOI: 10.7507/1002-0179.20130413.

14.张玲玲. 医护一体化快速康复外科护理对结直肠癌手术患者胃肠功能的影响[J]. 中华养生保健, 2023, 41(18): 90-93. [Zhang LL. The effect of integrated medical and nursing care in fast-track surgery on gastrointestinal function in patients undergoing colorectal cancer surgery[J]. Chinese Journal of Health Care and Maintenance, 2023, 41(18): 90-93.] DOI: 10.3969/j.issn.1009-8011.2023.18.028.

15.国家卫生健康委员会医政司, 中华医学会肿瘤学分会. 国家卫健委中国结直肠癌诊疗规范（2023版）[J]. 中国实用外科杂志, 2023, 43(6): 602-630. DOI: 10.19538/j.cjps.issn1005-2208.2023.06.02.

16.中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会结直肠外科学组, 中国医师协会外科医师分会结直肠外科专家工作组, 等. 腹腔镜结直肠癌根治术操作指南（2023版）[J]. 中华消化外科杂志, 2024, 23(1): 10-22. DOI: 10.3760/cma.j.cn115610-20231229-00285.

17.中国微循环学会周围血管疾病专业委员会下肢静脉腔内治疗专业委员会. 下肢深静脉血栓形成后综合征腔内治疗专家共识[J]. 血管与腔内血管外科杂志, 2023, 9(7): 769-776, 787. DOI: 10.19418/j.cnki.issn2096-0646.2023.07.01.

18.Yasui M, Ikeda M, Hata T, et al. Risk factors for postoperative proximal deep vein thrombosis and pulmonary embolism after laparoscopic colorectal cancer surgery: analysis of a multicenter randomized controlled trial[J]. Surg Today. 2022, 52(6): 881-888. DOI: 10.1007/s00595-021-02422-2.

19.Lu X, Zeng W, Zhu L, et al. Application of the caprini risk assessment model for deep vein thrombosis among patients undergoing laparoscopic surgery for colorectal cancer[J]. Medicine, 2021, 100(4): e24479. DOI: 10.1097/MD.0000000000024479.

20.Popov J, Coelho S, Carrier M, et al. Step down to 6 months of prophylactic-dose low molecular weight heparin after initial full-dose anticoagulation for the treatment of cancer-associated thrombosis (STEP-CAT): a pilot study[J]. J Thromb Haemost, 2022, 20(8): 1868-1874. DOI: 10.1111/jth.15760.

21.赵静, 赵爱华, 吕建莉. 依诺肝素钠注射液预防髋关节置换术后下肢深静脉血栓形成的效果[J]. 临床医学, 2024, 44(4): 94-96. [Zhao J, Zhao AH, Lyu JL. The effect of enoxaparin sodium injection on preventing lower limb deep vein thrombosis after total hip arthroplasty[J]. Clinical Medicine, 2024, 44(4): 94-96.] DOI: 10.19528/j.issn.1003-3548.2024.04.030.

22.Cave BE, Shah SP. Turning up to eleven: factor XI inhibitors as novel agents to maximize safety and maintain efficacy in thromboembolic disease[J]. Curr Probl Cardiol, 2021, 46(3): 100696. DOI: 10.1016/j.cpcardiol.2020.100696.

23.Becattini C, Pace U, Pirozzi F, et al. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after iaparoscopic surgery for colorectal cancer[J]. Blood, 2022, 140(8): 900-908. DOI: 10.1182/blood.2022015796.

24.Caprini JA, Arcelus JI, Laubach M, et al. Postoperative hypercoagulability and deep-vein thrombosis after laparoscopic cholecystectomy[J]. Surg Endosc, 1995, 9(3): 304-309. DOI: 10.1007/BF00187774.

25.Song XJ, Liu ZL, Zeng R, et al. A meta-analysis of laparoscopic surgery versus conventional open surgery in the treatment of colorectal cancer[J]. Medicine, 2019, 98(17): e15347. DOI: 10.1097/MD.0000000000015347.