Deep Vein Thrombosis After Pleurectomy for Mesothelioma

The authors of a new study on deep vein thrombosis after pleurectomy say mesothelioma patients may be at special risk. They say routine screening after pleural mesothelioma surgery could save lives.

The study comes from Brigham and Women’s Hospital, a leader in cancer research. The research team followed a series of mesothelioma patients who agreed to be part of a DVT surveillance program. 

Nearly 30 percent of the patients experienced deep vein thrombosis after pleurectomy. A third of those patients had no symptoms.

Understanding DVT 

Deep vein thrombosis or DVT is when a blood clot forms in the deep veins of the arm, leg, or groin. If the clot goes unnoticed, it can travel through the circulation and lodge in the lungs. Clots that lodge in a pulmonary artery of the lungs can cause a pulmonary embolism (PE). PE can be fatal. 

Deep vein thrombosis after pleurectomy or another major surgery is not uncommon. Having cancer raises the risk even higher. 

Monitoring with ultrasound can sometimes find a clot before it becomes a major problem. But there are no guidelines about screening for DVT in mesothelioma surgery patients. 

Screen for Deep Vein Thrombosis After Pleurectomy

Pleural mesothelioma is a malignancy that affects the membrane around the lungs. There is no cure for pleural mesothelioma. If the tumor is contained, patients who are in otherwise good health may undergo pleurectomy. 

Pleurectomy with decortication (P/D) is a major operation during which surgeons remove the whole pleural membrane and other at-risk tissues in the chest. Deep vein thrombosis after pleurectomy is a serious threat. 

The new study included 93 mesothelioma patients who had P/D surgery. Patients without symptoms had ultrasound screening for DVT every 7 days after surgery. If a patient had DVT symptoms, screening happened earlier. 

Twenty-seven percent of the patients developed deep vein thrombosis after pleurectomy. Seven of those patients also had a pulmonary embolism. A third of the patients with DVT had no symptoms. The problem would have gone unnoticed without the screening. 

If a patient had DVT, they started on a blood thinner called heparin. Only a small percentage of patients developed bleeding problems from the treatment. 

“Up to 33% of patients with DVT are asymptomatic at the time of diagnosis, and the incidence of complications related to anticoagulation is low,” writes lead author Luis E.De León, MD. 

Dr. De León and his colleagues recommend routine ultrasound screening for mesothelioma patients after surgery. They say it may help find and treat deep vein thrombosis after pleurectomy “before it progresses to symptomatic or fatal PE.”

Source:

De León, et al, “Routine Surveillance for Diagnosis of Venous Thromboembolism After Pleurectomy for Malignant Pleural Mesothelioma”, January 30, 2020, Journal of Thoracic and Cardiovascular Surgery, Epub ahead of print, https://www.sciencedirect.com/science/article/abs/pii/S0022522320302348