# Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations

Source: https://onco.cc/protocols/vte-prophylaxis-after-cancer-surgery/  
OnCo record `vte-prophylaxis-after-cancer-surgery` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer and major surgery both raise the risk of blood clots in the legs and lungs. Before the operation the team should assess your risk of clots and of bleeding, use stockings or leg pumps, and usually give blood-thinning injections. After major cancer surgery in the abdomen or pelvis these are often continued at home for four weeks, because many clots happen after discharge.

## Summary

NICE NG89 (2018, updated 2019) asks for every surgical patient's VTE and bleeding risk to be assessed on admission with a published tool and reassessed at consultant review or when their condition changes. For abdominal (gastrointestinal, gynaecological, urological) surgery at increased risk, mechanical prophylaxis (anti-embolism stockings or intermittent pneumatic compression) starts on admission and continues until mobility returns, and LMWH or fondaparinux is added for at least 7 days where clot risk outweighs bleeding risk. NICE says to consider extending pharmacological prophylaxis to 28 days after major cancer surgery in the abdomen. For thoracic surgery the same pattern is 'consider'. ASCO (2023 update) added apixaban and rivaroxaban as options for extended prophylaxis after cancer surgery, with a weak recommendation. The Cochrane review (2019; 7 RCTs, 1728 participants, benign and malignant disease) found extended LMWH reduced VTE after major abdominal or pelvic surgery from 13.2% to 5.3% (OR 0.38, 95% CI 0.26 to 0.54, moderate-quality evidence), mostly clots found by scanning, with no difference in bleeding or mortality. Before discharge, people should be shown how to inject and dispose of needles, told how long to continue, and told the signs of DVT, pulmonary embolism and bleeding.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: VTE prophylaxis; thromboprophylaxis; extended thromboprophylaxis; 28 days of heparin injections after surgery; DVT prevention after cancer surgery; blood thinner injections after surgery; anti-embolism stockings

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Endometrial cancer](https://onco.cc/cancers/endometrial/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- technologies: [Cancer-associated thrombosis prevention and treatment](https://onco.cc/technologies/cancer-associated-thrombosis/)
- terms: [Venous thromboembolism (VTE)](https://onco.cc/terms/vte/)
- ideas: [Four weeks of blood-clot prevention after major abdominal or pelvic cancer surgery](https://onco.cc/ideas/idea-pu-extended-clot-prevention-after-surgery/)
- protocols: [Blood thinners around cancer surgery, biopsy and endoscopy: when to stop, whether to bridge, when to restart](https://onco.cc/protocols/antithrombotic-interruption-around-surgery/), [Enhanced recovery after breast reconstruction (ERAS pathway for implant and flap reconstruction)](https://onco.cc/protocols/enhanced-recovery-after-breast-reconstruction/), [Enhanced recovery after colorectal cancer surgery (ERAS pathway for bowel resection)](https://onco.cc/protocols/enhanced-recovery-after-colorectal-surgery/), [Enhanced recovery after cytoreductive surgery with or without HIPEC](https://onco.cc/protocols/enhanced-recovery-after-cytoreductive-surgery-and-hipec/), [Enhanced recovery after gastrectomy (ERAS pathway for stomach cancer surgery)](https://onco.cc/protocols/enhanced-recovery-after-gastrectomy/), [Enhanced recovery after gynaecological cancer surgery (ERAS pathway for gynaecologic oncology)](https://onco.cc/protocols/enhanced-recovery-after-gynaecological-cancer-surgery/), [Enhanced recovery after liver surgery (ERAS pathway for hepatectomy)](https://onco.cc/protocols/enhanced-recovery-after-liver-surgery/), [Enhanced recovery after lung cancer surgery (ERAS pathway for lung resection)](https://onco.cc/protocols/enhanced-recovery-after-lung-surgery/), [Enhanced recovery after major head and neck cancer surgery with free flap reconstruction](https://onco.cc/protocols/enhanced-recovery-after-head-and-neck-free-flap-surgery/), [Enhanced recovery after oesophagectomy (ERAS pathway for oesophageal cancer surgery)](https://onco.cc/protocols/enhanced-recovery-after-oesophagectomy/), [Enhanced recovery after pancreatoduodenectomy (ERAS pathway for the Whipple operation)](https://onco.cc/protocols/enhanced-recovery-after-pancreatoduodenectomy/), [Enhanced recovery after radical cystectomy (ERAS pathway for bladder removal)](https://onco.cc/protocols/enhanced-recovery-after-radical-cystectomy/), [Routine tests before planned surgery, by size of operation and fitness](https://onco.cc/protocols/routine-preoperative-tests/), [Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care](https://onco.cc/protocols/surgical-site-infection-prevention/)

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