Study Identifies Critical Risk Factors for VTE After Pulmonary Resection

Andrea L. Axtell, MD, MPH

Credit: University of Wisconsin

A new analysis demonstrated venous thromboembolism (VTE), a blood clot forming in a vein that can lead to pulmonary embolism, is a major potential postoperative complication after pulmonary resection for lung cancer.¹

The research, presented at the 2024 Society of Thoracic Surgeons (STS) Annual Meeting, showed patients with postoperative pulmonary embolism had increased 30-day mortality, reintubation, and readmission rates, with risk factors for embolism including Black race and interstitial fibrosis.

“Because the predominating risk factors for postoperative VTE identified in this analysis are non-modifiable, and because VTE-associated mortality is increased, enhanced awareness and targeted perioperative prophylactic measures should be considered in these high-risk cohorts,” said lead study author Andrea L. Axtell, MD, MPH, an assistant professor of surgery at the University of Wisconsin School of Medicine and Public Health.¹

Axtell and colleagues assessed data collected from the STS’s General Thoracic Surgery Database (GTSD), containing more than 700,000 procedure records and more than 1,000 participating surgeons. The team searched for anonymous results for 57,531 adult patients who underwent pulmonary resection between January 2009 and June 2021.

Among this population, 758 patients developed blood clots that moved to the lungs after surgery – these patients were more likely to be Black (12%) versus other races (7%). Vulnerable patients were also more likely to have interstitial fibrosis or scarring and inflammation of the lung. Overall, those with more advanced disease, as well as those who underwent bilobectomy or pneumonectomy, were more likely to develop pulmonary embolism.

After analysis of the GTSD, Axtell and colleagues found a 2.5% occurrence of postoperative VTE and a 1.3% occurrence of postoperative pulmonary embolism in patients undergoing a first-time pulmonary resection for lung cancer. The time-over-time trends suggest the incidence of postoperative VTE to remain largely unchanged over the 12-year study period.

However, in that period, the associated mortality rate decreased from 20% in 2009 to 8% in 2018. Investigators observed no difference in pulmonary embolism risk according to lung function before surgery, cancer cell type, or receipt of chemotherapy before surgery.

A previous analysis from the Centers for Disease Control and Prevention (CDC) found Black individuals in the United States experienced a 40% higher incidence of VTE overall, compared with White individuals.² Further data reported 2.8-fold odds increase of VTE in patients with lung cancer.³ Thus, the team indicated Black race as a predisposing factor for VTE was confirmed by their analysis findings.¹

“While this difference is likely multi-factorial, previous investigations have suggested genetic variability, socioeconomic factors, and health disparities in access to high-volume, subspecialized care,” Axtell said.¹

Axtell and colleagues indicated further steps for individuals at risk for embolism after pulmonary resection for lung cancer could include more imaging, particularly in the legs where blood clots form, or a longer course of blood thinners to prevent clot formation occurrences.

“By increasing awareness of the increased risk for VTE in Black patients, the team hopes to encourage more focused preventative measures in these patients,” Axtell added.¹

References

1. _{Breakthrough Research Identifies Predictors of Venous Thromboembolism after Pulmonary Resection for Lung Cancer. Newswise. January 24, 2024. Accessed January 30, 2024. https://www.newswise.com/articles/breakthrough-research-identifies-predictors-of-venous-thromboembolism-after-pulmonary-resection-for-lung-cancer.}
2. _{Heit JA, Beckman MG, Bockenstedt PL, et al. Comparison of characteristics from White- and Black-Americans with venous thromboembolism: a cross-sectional study. Am J Hematol. 2010;85(7):467-471. doi:10.1002/ajh.21735}
3. _{Addo-Tabiri NO, Chudasama R, Vasudeva R, et al. Black Patients Experience Highest Rates of Cancer-associated Venous Thromboembolism. Am J Clin Oncol. 2020;43(2):94-100. doi:10.1097/COC.0000000000000639}