Beyond prophylaxis: Extended risk of venous thromboembolism following primary debulking surgery for ovarian cancer

Wagner, B.; Langstraat, Carrie; McGree, Michaela E.; Weaver, Amy L.; Sarangi, Siddharth; Mokri, Bahareh; Dowdy, Sean C.; Cliby, William A.; Kumar, Amanika; Bakkum-Gamez, Jamie N.

doi:10.1016/j.ygyno.2018.11.021

Cited by 28 publications

(27 citation statements)

References 23 publications

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“…Approximately 3% of women with a new ovarian cancer diagnosis will have a concomitant VTE diagnosed before they start cancer treatment52; the risk of VTE approaches 12% during neoadjuvant chemotherapy55 and extends through at least the full course of primary therapy 56. The extended risk of VTE was also demonstrated in an analysis from the Million Women Study that showed the risk of VTE at 12 weeks post-operatively was 1/85 for cancer surgery and 1/365 for gynecologic surgery 57.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

Int J Gynecol Cancer

514

364

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BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

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Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

Int J Gynecol Cancer

514

364

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“…16,17 Although LMWH prophylaxis reduces VTE after surgery, a considerable number of patients still suffer a thrombosis despite compliance with the recommended thromboprophylaxis. 9,11 In this study, we have developed and validated a risk score, which can predict VTE occurrence in patients with gynecologic cancer in the 24 months following cancer staging surgery. The performance of this score was enhanced by extending 18,19 Several models exist for prediction of VTE in cancer; however, none are appropriate for patients with gynecologic cancer following surgery.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Although extended prophylaxis is effective, 7 the optimal duration of prophylaxis is unclear. 8,9 Several groups have suggested that extended prophylaxis is not necessary in all patients with gynecologic cancer, particularly those undergoing minimally invasive surgery. [10][11][12] In addition, we and others have shown that use of extended prophylaxis is low in many centers.…”

Section: Introductionmentioning

confidence: 99%

A risk score for prediction of venous thromboembolism in gynecologic cancer: The Thrombogyn score

Norris

Ward

O’Toole

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Gynecologic cancers are associated with high rates of venous thromboembolism (VTE), which is exacerbated by pelvic surgery and chemotherapy. Objectives The aim of this study was to develop and validate a risk score for VTE in patients with gynecologic cancer and to test the predictive ability of the score following addition of procoagulant biomarker data. Patients and methods Clinical and laboratory variables were used to develop a risk score for the prediction of VTE in patients with gynecological cancer (n = 616), which was validated in a separate cohort of patients (n = 406). Endogenous thrombin potential and D‐dimer levels were determined in a subset (n = 290) of patients and used to produce an extended score in the validation cohort. Results Multivariable regression analysis identified BMI >30, hemoglobin <11.5 g/dL and chemotherapy as independent predictors of VTE, which formed the Thrombogyn score. Following competing risk regression analysis, subdistribution hazard ratios (SHRs), adjusted for cancer stage, were 8.16 (95% confidence interval [CI], 1.69‐43.77) in the high‐risk group (score = 2‐3) and 4.12 (95% CI, 0.85‐20.15) in the intermediate‐risk group (score = 1) compared with the low‐risk group (score = 0). SHRs for the validation cohort were 6.26 (95% CI, 1.24‐31.39) and 3.00 (95% CI, 0.67‐13.32), respectively. Cumulative incidence of VTE in the validation cohort high‐risk group was 10.34% (95% CI, 6.51‐16.41) per women‐years compared with 1.06% (95% CI, 0.26‐4.26) in the low‐risk group. Using the extended Thrombogyn score, adjusted SHRs were 16.83 (95% CI, 4.20‐67.37) in the high‐risk group with a cumulative incidence of 21.15% (95% CI, 10.32‐45.24). External validation of the score is required. Conclusions The Thrombogyn score identifies patients with gynecologic cancer at high and low risk of VTE. Addition of biomarker data improves the predictive power of the score.

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“…Patients with cancer who undergo surgery are at particularly high risk for VTE, especially if the surgery is long and the blood loss substantial [10]. Balancing the costs of screening tests for VTE against the risk of missed diagnoses will be important so we can identify which patients should receive routine screening tests, and which ones should undergo diagnostic imaging only if symptoms of VTE arise.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%

“…Many thromboprophylaxis regimens are used in an attempt to minimize VTE, as seen by the highly varied regimens used in the current study by Groot and colleagues [3]. Despite aggressive perioperative thromboprophylaxis, the risk for postoperative VTE is prolonged well past the perioperative hospital stay [10]. It is clear that measures should be taken to try to prevent VTE in patients undergoing surgery for spinal metastases.…”

mentioning

confidence: 91%

CORR Insights®: High Risk of Symptomatic Venous Thromboembolism After Surgery for Spine Metastatic Bone Lesions: A Retrospective Study

Ghert

2019

Clin Orthop Relat Res

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The author certifies that neither she, nor any members of her immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR ® or The Association of Bone and Joint

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Beyond prophylaxis: Extended risk of venous thromboembolism following primary debulking surgery for ovarian cancer

Cited by 28 publications

References 23 publications

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

A risk score for prediction of venous thromboembolism in gynecologic cancer: The Thrombogyn score

CORR Insights®: High Risk of Symptomatic Venous Thromboembolism After Surgery for Spine Metastatic Bone Lesions: A Retrospective Study

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