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SYSTEMATIC REVIEW article

Front. Oncol.
Sec. Surgical Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1445485

Comparison of efficacy and safety of thrombus prevention strategies after abdominal and pelvic cancer surgery: Bayesian network based meta-analysis

Provisionally accepted
Shiran Qin Shiran Qin 1,2*Sitong Guo Sitong Guo 1Yucheng Yao Yucheng Yao 1,2Ying He Ying He 1*Dandan Xu Dandan Xu 1,3*Henghai Su Henghai Su 1*Xiaoyu Chen Xiaoyu Chen 1*Haoru Meng Haoru Meng 1*
  • 1 People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
  • 2 Guangxi Medical University, Nanning, Guangxi Zhuang Region, China
  • 3 School of Pharmacy, Guilin Medical University, Guilin, Guangxi Zhuang Region, China

The final, formatted version of the article will be published soon.

    The occurrence of venous thromboembolism (VTE) after abdominal and pelvic cancer surgery increases the risk of mortality and disability. However, there is insufficient evidence supporting the choice of anticoagulation strategies.We searched PubMed, The Cochrane Library, Embase, and Web of Science for randomized controlled trials from inception to January 2024. Studies concerning thrombosis prevention after abdominal and pelvic surgery were included. Network meta-analysis(NMA) and direct meta-analysis (DMA) methods were employed to evaluate the efficacy and safety of various prophylactic strategies.Results: Twenty clinical trials involving a total of 4923 patients were included. The DMA results showed that low molecular weight heparin (LMWH) was more effective in preventing VTE compared to no treatment (OR = 1.96; 95% CI: 1.21 to 3.19), and LMWH plus physiotherapy was more effective than LMWH (OR = 10.95; 95% CI: 1.33 to 90.40). The NMA results indicated that DOACs (OR = 0.34; 95% CI: 0.11 to 0.76) and LMWH (OR = 0.51; 95% CI: 0.32 to 0.77) were significantly effective in preventing venous thrombosis compared with no treatment. The cumulative ranking probability curve (SUCRA) showed that direct oral anticoagulants (DOACs) were the best intervention. In terms of major bleeding, unfractionated heparin (UFH) had a higher risk than LMWH, physiotherapy, and no treatment, with statistically significant differences. The SUCRA analysis indicated that physiotherapy was the best intervention for major bleeding. Conclusion: Existing evidence suggests that DOACs can provide better thromboprophylaxis efficacy for patients after abdominal and pelvic cancer surgery, achieving an optimal balance between efficacy and safety. LMWH has become an intervention with efficacy second only to DOACs, with similar safety.

    Keywords: Cancer, Surgery, Venous Thromboembolism, DOAC, Meta-analysis

    Received: 14 Jun 2024; Accepted: 13 Jan 2025.

    Copyright: © 2025 Qin, Guo, Yao, He, Xu, Su, Chen and Meng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Shiran Qin, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
    Ying He, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
    Dandan Xu, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
    Henghai Su, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
    Xiaoyu Chen, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
    Haoru Meng, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China

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