Extended dalteparin still linked to fewer clots after ERAS colorectal surgery

Design

Retrospective single-centre cohort

Population

1,043 adults after elective minimally invasive colorectal resection for neoplasia within ERAS

Primary outcome

Symptomatic VTE within 30 days after discharge

Effect

1.4% (5/351) without vs 0.1% (1/692) with extended prophylaxis; p = 0.010; no bleeding difference

A retrospective cohort in Surgical Endoscopy (7 October) included 1,043 adults having elective minimally invasive colorectal resection for neoplasia at a high-volume Canadian centre between 2016 and 2024, all within a mature enhanced recovery (ERAS) programme. Everyone received in-hospital prophylaxis; 692 also received dalteparin 5,000 units daily for 28 days after discharge, which became protocol from 2018, and 351 did not.

Symptomatic VTE within 30 days after discharge occurred in 0.5% overall. It was more common without extended prophylaxis (5 of 351, 1.4%) than with it (1 of 692, 0.1%), and bleeding did not differ between the groups.

A common argument is that early mobilisation, short stays and laparoscopy make extended prophylaxis unnecessary. These data do not support dropping it: the absolute risk is low, but the difference persisted inside a well-run ERAS pathway without a bleeding cost. Guidelines that recommend up to 28 days after major abdominal or pelvic cancer surgery have not changed, and this study gives no reason to depart from them.

• Continue 28-day extended thromboprophylaxis after major abdominal or pelvic cancer resection, including within ERAS.
• Teach patients or carers to give the injections before discharge and check they have a full supply.
• Confirm adherence at the first post-discharge contact.
• Assess bleeding risk before prescribing, since this study did not test high-bleeding-risk patients separately.
• Tell patients the warning signs of DVT and pulmonary embolism to report after discharge.

Why it matters

It answers the question many ERAS units are asking about dropping extended prophylaxis, and the answer is not yet.

Don't overread it

With only six events and a before-after design, this cannot give a precise size of benefit.

The statistics, in plain English

1.4% versus 0.1% is an absolute difference of about 1.3 percentage points, roughly one clot prevented for every 77 patients treated. With only six events in total, that estimate is fragile, and changes in practice over time may also explain part of the difference.

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