Clinically significant thromboembolic disease in orthopedic oncology: An analysis of 986 patients treated with low‐molecular‐weight heparin

Ruggieri, Pietro; Montalti, Maurizio; Pala, Elisa; Angelini, Andrea; Calabrò, Teresa; Errani, Costantino; Mercuri, Mario

doi:10.1002/jso.21645

Cited by 14 publications

(11 citation statements)

References 48 publications

(83 reference statements)

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“…In this study, the incidence of DVT was comparable to Kim et al, Mitchell et al, Patel et al, and Benevenia et al, even though our patients were asymptomatic. There are few retrospective studies reporting a lower incidence of DVT in patients who underwent oncology lower limb surgery (Heit et al 2000 ; Mitchell et al 2007 ; Ramo et al 2011 ; Ruggieri et al 2010 ). The incidence ranged from 1.1 to 2.4 % for DVT and 0.1 to 2.3 % for PE.…”

Section: Discussionmentioning

confidence: 99%

“…Ramo et al ( 2011 ) studied the incidence of DVT in 423 patients who underwent endoprosthesis replacement and he concluded that the incidence of symptomatic venous thromboembolism in their group of cancer patients who underwent lower-extremity endoprosthetic arthroplasty was lower than anticipated. Ruggieri et al ( 2010 ) looked at his population of 986 patients with uncemented endoprosthesis. He concluded that the clinical occurrence of this DVT was extremely low probably due to a consistent and careful prophylaxis, prolonged until the time of complete weight-bearing.…”

Section: Discussionmentioning

confidence: 99%

“…There are a few retrospective studies on the incidence of symptomatic venous thromboembolism after orthopedic surgeries in oncology patients. These studies reported that the rate of DVT and PE among these patients ranged from 1.1 to 5 % and 0.6 to 2.3 % respectively (Jeys et al 2008 ; Kim et al 2013 ; Mitchell et al 2007 ; Morii et al 2010 ; Patel et al 2010 ; Ramo et al 2011 ; Ruggieri et al 2010 ).…”

Section: Introductionmentioning

confidence: 99%

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Is DVT prophylaxis necessary after oncology lower limb surgery? A pilot study

2016

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Background Deep vein thrombosis (DVT) has been independently associated with both malignant diseases and orthopaedic surgery. Therefore, orthopaedic oncology patients may be at a high risk for thromboembolic events. However, less emphasis is given to this group of patients compared to the patients undergoing total hip and knee replacement. The objective of this study is to determine the incidence of DVT and their risk factors in patients undergoing orthopaedic oncology lower limb surgery without prophylaxis.Questions/purposes(1) What is the incidence of DVT in patients who underwent orthopaedic oncology surgery for the lower limb? (2) What are the risk factors related to DVT in patients who underwent oncology surgery of the lower limb surgery? (3) This is a pilot study to determine if further trial is warranted.MethodsThis is a prospective study. All sequential patients undergoing orthopaedic oncology operations from the period of 1st October 2013 till 30th September 2014 were recruited for the study with their consent. Their demographic data, diagnosis and surgery were documented. Thirty-eight patients who underwent lower limb surgeries for orthopaedic oncology indications were included in the study. No tourniquet was used in these lower limb surgeries. There were 24 men and 14 women with a mean age of 36 years (11–75). All potential risk factors were also identified and documented. All patients were not given any form of DVT prophylaxis (mechanical and chemical) before and after operation as this is a standard protocol in our center and a Medical Ethics Committee approval was taken for this study. DVT surveillance was performed 1 day before operation and 2 weeks after operation with ultrasound Doppler. Patients diagnosed with DVT via ultrasound Doppler were subsequently scheduled for CTPA to look for pulmonary embolism (PE).ResultsDVT was detected in two patients (5 %). Both patients were asymptomatic and they both had proximal thrombosis. One patient (2.6 %) was diagnosed with non-fatal PE and was asymptomatic. PE was detected incidentally by staging computed tomography scan and the patient had negative ultrasound Doppler of the operated and non-operated limb for DVT. We did not carry out a statistical analysis as the study population with DVT and pulmonary embolism is small.ConclusionsThe incidence of DVT in patients after undergoing orthopaedic oncology lower limb surgery was low even without prophylaxis at our center. Further investigation with larger sample size is needed to validate our results and identify the risk factors.Level of evidenceLevel III descriptive study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is DVT prophylaxis necessary after oncology lower limb surgery? A pilot study

2016

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“…[4][5][6][7][8][9] It is, however, extremely difficult to compare the incidence of VTE from the literature, because the characteristics of the patients, the type of VTE prophylaxis and the method of DVT detection differ between reports.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] However, a small number of studies have shown that there is a risk of significant venous thromboembolism (VTE). [4][5][6][7][8][9] VTE, which includes deep-vein thrombosis (DVT) and pulmonary thromboembolism (PTE), is recognised as a serious complication of major surgery. Patients undergoing operations for cancer and orthopaedic surgery on the lower limbs are at particular risk.…”

Section: Cite This Article: Bone Joint J 2013;95-b:1280-4mentioning

confidence: 99%

Deep-vein thrombosis after resection of musculoskeletal tumours of the lower limb

Yamaguchi

Matsumine

Niimi

et al. 2013

The Bone & Joint Journal

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The aim of this study was to define the incidence of venous thromboembolism (VTE) and risk factors for the development of deep-vein thrombosis (DVT) after the resection of a musculoskeletal tumour. A total of 94 patients who underwent resection of a musculoskeletal tumour between January 2003 and December 2005 were prospectively studied. There were 42 men and 52 women with a mean age of 54.4 years (18 to 86). All patients wore intermittent pneumatic compression devices and graduated compression stockings. Ultrasound examination of the lower limbs was conducted to screen for DVT between the fifth and ninth post-operative days. DVT was detected in 21 patients (22%). Of these, two were symptomatic (2%). One patient (1%) had a fatal pulmonary embolism. Patients aged ≥ 70 years had an increased risk of DVT (p = 0.004). The overall incidence of DVT (both symptomatic and asymptomatic) after resection of a musculoskeletal tumour with mechanical prophylaxis was high. It seems that both mechanical and anticoagulant prophylaxis is needed to prevent VTE in patients who have undergone the resection of a musculoskeletal tumour.

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Venous thromboembolism rates in patients with bone and soft tissue sarcoma of the extremities following surgical resection: A systematic review

Krzyzaniak

You

Mosca

et al. 2021

Journal of Surgical Oncology

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Background: Patients undergoing an orthopedic surgery for bone or soft tissue sarcoma are at increased venous thromboembolism (VTE) risk. Unfortunately, there is a lack of thromboprophylaxis guidelines in this population. The purpose of this systematic review was to determine the soft tissue and bone sarcoma VTE rate and to explore the thromboprophylaxis regimens used.Methods: The databases MEDLINE, EMBASE, and CENTRAL were queried using keywords related to VTE and long bone malignancy requiring surgical intervention to 2020. Included studied reported VTE rate in patients with surgically managed extremity sarcoma. Descriptive statistics and weighted mean totals were calculated.Results: A total of 2082 studies were screened and 23 studies were included. The overall VTE rate was 2.9%, with a rate of 3.7% and 1.4% in patients with bone and soft tissue sarcomas, respectively. Low-molecular-weight heparin was the most commonly used chemoprophylaxis.Conclusions: There is a high VTE rate following sarcoma surgery. The VTE rate is higher in bone sarcoma surgery, which may be attributed to differences in surgery and postoperative recovery. There was no consensus on the duration or type of thromboprophylaxis used. Future research is needed to determine the most effective thromboprophylaxis regimen in patients with sarcoma and whether individualized thromboprophylaxis is required.

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Clinically significant thromboembolic disease in orthopedic oncology: An analysis of 986 patients treated with low‐molecular‐weight heparin

Abstract: Despite general oncologic and orthopedic factors favoring VTE, the clinical occurrence of this event was extremely low in this series, probably due to a consistent and careful prophylaxis, prolonged until the time of complete weight-bearing.

Cited by 14 publications

References 48 publications

Is DVT prophylaxis necessary after oncology lower limb surgery? A pilot study

Is DVT prophylaxis necessary after oncology lower limb surgery? A pilot study

Deep-vein thrombosis after resection of musculoskeletal tumours of the lower limb

Venous thromboembolism rates in patients with bone and soft tissue sarcoma of the extremities following surgical resection: A systematic review

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