Routine Surveillance for Diagnosis of Venous Thromboembolism After Pleurectomy for Malignant Pleural Mesothelioma

Abstract Objective The purpose of this study was to determine the incidence of venous thromboembolism (VTE) and utility of a routine surveillance program in patients undergoing surgery for mesothelioma. Methods Patients undergoing pleurectomy from May 2016–August 2018 were included. A standardized surveillance program to look for VTE in this group included noninvasive studies every 7 days postoperatively, or earlier if symptomatic. All patients received external pneumatic compression sleeves in addition to prophylactic heparin. If either deep vein thrombosis (DVT) or pulmonary embolus (PE) were discovered, heparin drip was initiated until conversion to therapeutic anticoagulation. Results One hundred patients underwent pleurectomy for mesothelioma. Seven were found to have preoperative DVT, and as such only 93 patients were included for analysis. Median age at surgery was 71 years (30–85 years). During the study, 30(32%) patients developed evidence of thrombosis.: 20(22%) developed only DVT without embolism, 3(3%) only PE and 7(7%) both DVT and PE. Of the 27 patients who developed DVT, 9(33%) were asymptomatic at the time of diagnosis, and none of these developed a PE or other bleeding complications. There were 2(2%) events of major postoperative bleeding related to therapeutic anticoagulation. Conclusions The incidence of VTE is high (32%) among patients undergoing surveillance after pleurectomy for mesothelioma. Up to 33% of patients with DVT are asymptomatic at the time of diagnosis, and the incidence of complications related to anticoagulation is low. Routine surveillance may be useful diagnose and treat DVT before it progresses to symptomatic or fatal PE.