Incidence and Predictors of Venous Thromboembolism After Debulking Surgery for Epithelial Ovarian Cancer

Mokri, Bahareh; Mariani, Andrea; Heit, John A.; Weaver, Amy L.; McGree, Michaela E.; Martin, John R.; Lemens, Maureen A.; Cliby, William A.; Bakkum-Gamez, Jamie N.

doi:10.1097/igc.0b013e3182a80aa7

Cited by 37 publications

(15 citation statements)

References 27 publications

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“…However, the choice of VTE prophylaxis was relatively consistent in our study for each year included and patients were followed up for an extended duration of time. 19 Additionally, superficial incisional SSI risk may be reducible in type II surgical cases. At the time of the study, prophylactic antibiotic use within 30 minutes of incision was standard practice.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

AlHilli¹,

Langstraat²,

Tran

et al. 2015

Int J Gynecol Cancer

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Background To identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery. Methods Patients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection. Results In total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89; P = 0.007), ascites [1.76 (1.11–2.81); P = 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21); P = 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33; P = 0.04). Conclusions Clinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce costs.

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

AlHilli¹,

Langstraat²,

Tran

et al. 2015

Int J Gynecol Cancer

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“…Because gynecologic tumors growing within the pelvis involve lymphatic drainage in direct contact with lower extremity vessels, VTE rates are significantly higher in women with gynecologic cancer compared with other cancers. 5,6 Rates of DVT after gynecologic cancer have been reported as high as 26% in untreated women and as high as 9% for postoperative PE. 7 Pulmonary embolism is associated with mortality, and death may occur in up to 18% to 20% of patients with this complication.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Apixaban vs Enoxaparin for Preventing Postoperative Venous Thromboembolism in Women Undergoing Surgery for Gynecologic Malignant Neoplasm

et al. 2020

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IMPORTANCE Current guidelines recommend a 28-day course of enoxaparin for thromboprophylaxis after surgery for gynecologic cancer. The high cost of this medication and the low adherence rates observed in prior studies provide an opportunity to benefit patients by demonstrating the safety of a more cost-effective, easier to use thromboprophylactic. OBJECTIVE To investigate the safety and efficacy of an oral treatment alternative for thromboprophylaxis in postoperative patients with gynecologic cancer. DESIGN, SETTING, AND PARTICIPANTS This was a patient-based, multicenter, open-label, blinded, end point, randomized clinical trial conducted May 2015 to March 2019 in outpatient and inpatient gynecologic oncology settings. Women undergoing surgery for suspected or confirmed gynecologic cancer were approached for recruitment. The trial compared rates of major bleeding and clinically relevant nonmajor bleeding events during a 90-day follow-up period in patients taking apixaban or enoxaparin for postoperative thromboprophylaxis using a modified intent-to-treat analysis. Data analysis was performed from October to December 2019. INTERVENTIONS Women were randomized to 28 days of apixaban (2.5 mg orally twice daily) or enoxaparin (40 mg subcutaneously daily). MAIN OUTCOMES AND MEASURES The primary outcome was major bleeding and clinically relevant nonmajor bleeding events. Secondary outcomes included incidence of venous thromboembolic events, adverse events, medication adherence, participant quality of life, and medication satisfaction. RESULTS Of 500 women recruited for the study, 400 were enrolled and randomized (median age, 58.0 years; range, 18.0-89.0 years); 204 received apixaban and 196 received enoxaparin. Treatment groups did not differ in terms of race/ethnicity, cancer stage, or surgery modality (open vs robotic). There were no statistically significant differences between the apixaban and enoxaparin groups in terms of rates of major bleeding events (1 patient [0.5%] vs 1 patient [0.5%]; odds ratio [OR], 1.04; 95% CI, 0.07-16.76; P > .99), clinically relevant nonmajor bleeding events (12 patients [5.4%] vs 19 patients [9.7%]; OR, 1.88; 95% CI, 0.87-4.1; P = .11), venous thromboembolic events (2 patients [1.0%] vs 3 patients [1.5%]; OR, 1.57; 95% CI, 0.26-9.50; P = .68), adverse events, medication adherence, or quality of life between the groups. Participant satisfaction was significantly greater in the apixaban group with regard to ease of taking the medication (186 patients [98.9%] vs 110 (continued) Key Points Question Is there an efficacious and safe oral treatment for thromboprophylaxis in postoperative patients with suspected gynecologic malignant neoplasms? Findings This multicenter randomized clinical trial included 400 women randomized to either oral apixaban or subcutaneous enoxaparin. There were no differences between groups for rates of major bleeding (0.5% vs 0.5%), clinically relevant nonmajor bleeding (5.4% vs 9.7%), and venous thromboembolic events (1.0% vs 1.5%); although adherence rates did not d...

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“…More importantly, additional RCTs attested that, when mechanical measures are applied on the lower extremities (e.g. during operations), effectively eliminating the pathogenetic factor of blood velocity favoring lower over upper extremity VTE, lower extremity does not merely approximate the upper extremity VTE rate—the latter being extremely low in several postoperative series, especially if no local factors like central lines provoke upper extremity VTE (Browse and Negus 1970 ; Muñoz et al 2008 ; Koo et al 2014 ; Mokri et al 2013 ).…”

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confidence: 99%

Electrical muscle stimulation in thomboprophylaxis: review and a derived hypothesis about thrombogenesis—the 4th factor

Stefanou

2016

SpringerPlus

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IntroductionElectrical muscle stimulation (EMS) is an FDA-approved thromboprophylactic method. Thrombus pathogenesis is considered to depend on factors related to components of the vessel wall, the velocity of blood, and blood consistency—collectively known as, the Virchow’s triad.ObjectiveThe testimony supporting the thromboprophylactic effects of the EMS is reviewed. An emphasis is placed on the fact that, EMS has demonstrated, in certain circumstances, an efficacy rate that cannot be fully explained by the Virchow’s triad; also that, in reviewing relevant evidence and the theorized pathophysiological mechanisms, several findings collectively point to a potentially missed point. Remarkably, venous thromboembolic disease (VTE) is extremely more common in the lower versus the upper extremities even when the blood velocities equalize; EMS had synergistic effects with intermittent compressive devices, despite their presumed identical mechanism of action; sleep is not thrombogenic; non-peroperative EMS is meaningful only if applied ≥5 times daily; neural insult increases VTEs more than the degree expected by the hypomobility-related blood stasis; etc. These phenomena infer the presence of a 4th thrombogenetic factor: neural supply to the veins provides direct antithrombic effects, by inducing periodic vessel diameter changes and/or by neuro-humoral, chemically acting factors. EMS may stimulate or substitute the 4th factor. This evidence-based hypothesis is analyzed.ConclusionA novel pathophysiologic mechanism of thrombogenesis is supported; and, based on this, the role of EMS in thromboprophylaxis is expanded. Exploration of this mechanism may provide new targets for intervention.

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Incidence and Predictors of Venous Thromboembolism After Debulking Surgery for Epithelial Ovarian Cancer

Cited by 37 publications

References 27 publications

Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

Safety and Efficacy of Apixaban vs Enoxaparin for Preventing Postoperative Venous Thromboembolism in Women Undergoing Surgery for Gynecologic Malignant Neoplasm

Electrical muscle stimulation in thomboprophylaxis: review and a derived hypothesis about thrombogenesis—the 4th factor

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