Venous Thromboembolism—Incidence of Deep Venous Thrombosis and Pulmonary Embolism in Patients with Head and Neck Cancer: A Tertiary Care Experience in Pakistan

Ali, Naeem Sultan; Nawaz, Ahmad; Junaid, Montasir; Kazi, Maliha; Akhtar, Shabbir

doi:10.1055/s-0035-1549153

Cited by 21 publications

(14 citation statements)

References 28 publications

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“…[41][42][43] The VTE rate in our population (3.92%) was similar to previously published studies. 4,16,[44][45][46] Though it is known that patients requiring microsurgical H&N surgery are at high risk of VTE, authors have not reached a consensus on the importance of elevated BMI in this risk spectrum. In a review of 134 patients undergoing H&N microvascular reconstruction, Thai et al 9 reported a 29% increase in the risk of VTE associated with elevated BMI in patients with H&N cancer after controlling for several factors.…”

Section: Discussionmentioning

confidence: 99%

Assessment of BMI and Venous Thromboembolism Rates in Patients on Standard Chemoprophylaxis Regimens After Undergoing Free Tissue Transfer to the Head and Neck

Saadoun

Bengür

Moroni

et al. 2022

JAMA Otolaryngol Head Neck Surg

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ImportanceVenous thromboembolism (VTE) is a severe complication after free tissue transfer to the head and neck (H&amp;N). Enoxaparin 30 mg twice daily (BID) is a common regimen for chemoprophylaxis. However, differences in enoxaparin metabolism based on body weight may influence its efficacy and safety profile.ObjectiveTo assess the association between BMI and postoperative VTE and hematoma rates in patients treated with prophylactic enoxaparin 30 mg BID.Design, Setting, and ParticipantsThis was a retrospective review of a prospectively collected cohort from 2012 to 2022. Postoperative VTE, hematoma, and free flap pedicle thrombosis were recorded within 30 days of index surgery. The setting was a tertiary academic referral center. Participants included patients undergoing H&amp;N reconstruction with free flaps that received fixed-dose subcutaneous enoxaparin 30 mg BID postoperatively. Statistical analysis was conducted from April to May 2022.Main Outcomes and MeasuresOutcomes include incidence of VTE, hematoma, and flap pedicle thrombosis events within 30 days of the surgery. Univariate and multivariable regression models were used to evaluate associations between BMI and other patient factors with these outcomes.ResultsAmong the 765 patients included, 262 (34.24%) were female; mean (SD) age was 60.85 (12.64) years; and mean (SD) BMI was 26.36 (6.29). The rates of VTE and hematoma in the cohort were 3.92% (30 patients) and 5.09% (39 patients), respectively. After adjusting for patient factors, BMI was the only factor associated with VTE (OR, 1.07; 95% CI, 1.015-1.129). Obesity (BMI &gt;30) was associated with increased odds of VTE (OR, 2.782; 95% CI, 1.197-6.564). Hematoma was not associated with BMI (OR, 0.988; 95% CI, 0.937-1.041). Caprini score of at least 9 was not associated with VTE (OR, 1.259; 95% CI, 0.428-3.701).Conclusions and RelevanceThis cohort study found that obesity was associated with an increased risk of VTE in patients after microvascular H&amp;N reconstruction and while on standard postoperative chemoprophylaxis regimens. This association may suggest insufficient VTE prophylaxis in this group and a potential indication for weight-based dosing.

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Section: Discussionmentioning

confidence: 99%

Assessment of BMI and Venous Thromboembolism Rates in Patients on Standard Chemoprophylaxis Regimens After Undergoing Free Tissue Transfer to the Head and Neck

Saadoun

Bengür

Moroni

et al. 2022

JAMA Otolaryngol Head Neck Surg

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“…PE is the sudden blockage of the pulmonary artery or its branches by an embolus from the venous system or the right heart, which is characterized by dysfunction of the pulmonary circulation and respiratory system. Reported studies suggest that the incidence of this complication varies between 0.05 and 2.17% in otolaryngologic diseases [ 3 – 6 ]. In a recent survey in our hospital, the incidence and mortality of postoperative PE in head and neck cancers patients were 0.37 and 0.11%, respectively [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative hypotension, oliguria and operation time are associated with pulmonary embolism after radical resection of head and neck cancers: a case control study

et al. 2021

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Background Postoperative pulmonary embolism (PE) is a serious thrombotic complication in the patients with otolaryngologic cancers. We investigated the risk factors associated with postoperative PE after radical resection of head and neck cancers. Methods A total of 3512 patients underwent head and neck cancers radical resection from 2013 to 2019. A one-to-three control group without postoperative PE was selected matched by age, gender, and type of cancer. Univariate analyses were performed for the perioperative patient data including hemodynamic management factors. Conditional logistic regression was used to analyze the factors and their odds ratios. Results Postoperative PE was prevalent in 0.85% (95%CI = 0.56–1.14). Univariate analyses showed that a high ASA grade, high BMI, and smoking history may be related to postoperative PE. There was significantly difference in operation time between the two groups, especially for> 4 h [22(78.6%) vs 43(51.2%), P = .011]. The urine output was lower [1.37(0.73–2.21) ml·kg− 1·h− 1 vs 2.14(1.32–3.46) ml·kg− 1·h− 1, P = .006] and the incidence of oliguria was significantly increased (14.3% vs 1.2%, P = .004) in the PE group. Multivariable conditional logistic regression showed postoperative PE were associated with the cumulative duration for intraoperative hypotension (OR = 2.330, 95%CI = 1.428–3.801, P = .001), oliguria (OR = 14.844, 95%CI = 1.089–202.249, P = .043), and operation time > 4 h (OR = 4.801, 95%CI = 1.054–21.866, P = .043). Conclusions The intraoperative hypotension, oliguria, and operation time > 4 h are risk factors associated with postoperative PE after radical resection of head and neck cancers. Improving intraoperative hemodynamics management to ensure adequate blood pressure and urine output may reduce the occurrence of such complications.

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“…Venous thromboembolism (VTE), which consists of deep venous thrombosis (DVT) and its sequela pulmonary embolism (PE), are the prominent causes of mortality following surgical procedures. 1 , 2 In the United States, an estimated 350,000–900,000 people develop VTE, of whom approximately 100,000 die. In addition, 30–50% of people with lower-extremity DVT develop postthrombotic syndrome.…”

Section: Introductionmentioning

confidence: 99%

<p>Venous Thromboembolism Risk and Thromboprophylaxis Assessment in Surgical Patients Based on Caprini Risk Assessment Model</p>

Tadesse¹,

Kedir²,

Fentie³

et al. 2020

RMHP

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Purpose Venous thromboembolism (VTE) is the most common preventable cause of hospitalization-associated mortality. In the absence of optimal prophylaxis and depending on the type of surgery and patient-related factors, the risk of developing VTE increases by 10% to 50%. We aimed to assess VTE risk and thromboprophylaxis among surgical patients hospitalized at surgical wards of Tikur Anbessa Specialized Hospital (TASH). Addis Ababa, Ethiopia. Materials and Methods A retrospective cross-sectional study was conducted from September 1, 2018 to February 28, 2019. Data were collected using a pretested observational checklist which is prepared based on the VTE Caprini risk assessment model. Then, the collected data were checked for completeness and finally entered and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Results Out of 155 admitted patients, almost equal numbers of males (49.68%) and females (50.32%) participated in the study with a mean age of 41.87±16.84 and an age range of 13 to 89 years. Undergoing major surgery, resting in bed for more than 3 days and having acute infections (including pneumonia) were the most frequently seen VTE risk factors. Most of the study participants (135, 87.10%) were at risk of developing VTE (>1 Caprini risk score), and 47.11% were in the highest risk category (≥5 Caprini score). The maximum and minimum total risk scores were 19 and 1, respectively with a mean score of 4.53±2.31. Among patients who were at risk of developing VTE and eligible for thromboprophylaxis, only 17.78% received thromboprophylaxis and two ineligible patients received prophylaxis. Parental unfractionated heparin twice or three times per day was the most widely used thromboprophylaxis regimen. A total of 29 (18.71%) patients had one or more contraindication(s) for thromboprophylaxis and three of them took prophylaxis despite the contraindications. Only 3 (1.93%) patients admitted to surgical wards developed VTE during hospitalization. Conclusion As per the Caprini risk assessment model, the majority of surgical patients treated at TASH were at risk of developing VTE. However, thromboprophylaxis was underutilized. The incidence of VTE was 1.93% in our study.

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Venous Thromboembolism—Incidence of Deep Venous Thrombosis and Pulmonary Embolism in Patients with Head and Neck Cancer: A Tertiary Care Experience in Pakistan

Cited by 21 publications

References 28 publications

Assessment of BMI and Venous Thromboembolism Rates in Patients on Standard Chemoprophylaxis Regimens After Undergoing Free Tissue Transfer to the Head and Neck

Assessment of BMI and Venous Thromboembolism Rates in Patients on Standard Chemoprophylaxis Regimens After Undergoing Free Tissue Transfer to the Head and Neck

Intraoperative hypotension, oliguria and operation time are associated with pulmonary embolism after radical resection of head and neck cancers: a case control study

<p>Venous Thromboembolism Risk and Thromboprophylaxis Assessment in Surgical Patients Based on Caprini Risk Assessment Model</p>

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