Presentation Details
| Thrombosis Rates and Use of Thromboprophylaxis after Discharge from Gynecologic Cancer-Related Surgery Leticia Campoverde, Alyssa Mercadel, Dan Morgenster, Asaad Trabolsi, Thomas Plate IV, Rachel Kronenfeld, Wei Zhao, Matthew Schlumbrecht , Gerald Soff. University of Miami, Miami, FL, USA |
Abstract
BACKGROUND: Cancer and major abdominopelvic surgeries each pose significant thrombosis risks, making cancer-related surgery highly susceptible to venous thromboembolism (VTE). Without post-operative thromboprophylaxis (TPX), VTE risk can reach 29% in the weeks following major cancer surgeries. National Comprehensive Cancer Network (NCCN) guidelines recommend anticoagulation for up to 4 weeks after such surgeries, primarily using low molecular weight heparin (LMWH). As a Quality Assessment/Quality Improvement (QA/QI) project, we assessed the VTE rates linked to various gynecologic cancer-related surgeries and the compliance with TPX in a large cancer-center cohort. Additionally, we sought to further characterize the thrombosis risk as a function of surgical procedure and cancer type. METHODS: Patients (pts) diagnosed with gynecologic cancer between January 1st, 2012, through September 15th, 2022, at our institution were identified through our tumor registry. Using an in-house automated text search tool from our electronic medical record (Epic®), combined with natural language processing review, venous thromboembolism (VTE) events were identified, with secondary adjudication by the study leader (GAS). VTE was defined as either lower extremity deep vein thrombosis (DVT) or pulmonary embolism (PE) diagnosed from the day of surgery until 90 days after surgery. Logistic regression was performed on binary outcomes for the presence of VTE and TPX use at discharge. Kaplan-Meier curves and Cox regression were used for overall survival analysis. RESULTS: 801 pts were identified who underwent gynecologic cancer-related surgery. The overall VTE rate was 1.9% (n=15) but the events were not equally distributed. Minimally invasive surgery (MIS), vulvovaginal surgery, and biopsies collectively were associated with VTE rate of 0.57% (n=3), even when considering that only 11.1% of those pts received TPX at discharge. VTE was more commonly diagnosed in patients who underwent open surgery (4.3%, n=12), with 5 pts (1.8%) having VTE events before discharge and 7 (2.5%) after discharge. In multivariable logistic regression analysis, open procedures were associated with a higher risk of thrombosis (RR 7.5, p <0.001). Notably, only 50% (139 of 279) of pts who underwent open surgery received TPX at the time of discharge. Within the open surgery cohort, there was an inverse correlation between the incidence of post-discharge VTE and the utilization of post-discharge TPX. Of the 139 patients who received post-discharge TPX, 1 (0.7%) developed VTE, compared with 6 (4.3%) of the 140 patients who did not receive post-discharge TPX. (RR 0.17, p= 0.12). There was no difference in overall survival in pts who received TPX and those who did not, up to 36 months after open surgery. CONCLUSIONS: Our findings suggest a tiered risk of post-operative VTE after gynecologic cancer surgery, with a clinically relevant risk observed only in women undergoing open surgery. In patients who underwent open surgery, TPX at discharge showed a trend towards a protective effect, although this result did not reach statistical significance, probably due to sample size. This supports the need for improved targeted thrombosis prophylaxis.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.