Incidence and Prevention of Venous Thromboembolism in Patients Undergoing Breast Cancer Surgery and Treated According to Clinical Pathways

Andtbacka, Robert H.I.; Babiera, Gildy; Singletary, S. Eva; Hunt, Kelly K.; Meric‐Bernstam, Funda; Feig, Barry W.; Ames, Frederick C.; Ross, Merrick I.; DeJesus, Yvette; Kuerer, Henry Mark

doi:10.1097/01.sla.0000193832.40178.0a

Cited by 85 publications

(60 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…71,75,78,79 A comprehensive list of population-based, procedure-specifi c estimates of the 91-day risk of clinically diagnosed VTE has been compiled from the California Patient Discharge Data Set. 76 Patient-specifi c factors also determine the risk of VTE, as demonstrated in several relatively large studies of VTE in mixed surgical populations. Independent risk factors in these studies include age .…”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

“…Examples of relatively low-risk procedures include laparoscopic cholecystectomy, appendectomy, transurethral prostatectomy, inguinal herniorrhaphy, and unilateral or bilateral mastectomy. [69][70][71][72][73][74][75][76] Openabdominal and open-pelvic procedures are associated with a higher risk of VTE. 75,77 VTE risk appears to be highest for patients undergoing abdominal or pelvic surgery for cancer.…”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

See 1 more Smart Citation

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,821

744

View full text Add to dashboard Cite

(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

show abstract

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,821

744

View full text Add to dashboard Cite

show abstract

“…In contrast, breast cancer was associated with a relatively low VTE risk in some studies. 1,11,44 Nevertheless, because of the relatively high prevalence of breast cancer, the occurrence of VTE in a patient with breast cancer is not uncommon. 38 Furthermore, the risk of VTE was shown to increase by 6-fold when patients with metastatic breast cancer were compared with those with localized disease.…”

Section: Vte Risk Assessment In Patients With Cancermentioning

confidence: 99%

Venous Thromboembolic Disease

Streiff¹,

Bockenstedt²,

Cataland³

et al. 2013

J Natl Compr Canc Netw

View full text Add to dashboard Cite

OverviewVenous thromboembolism (VTE) is a common and life-threatening condition in patients with cancer.1,2 Results from a retrospective study of hospitalized adult patients with cancer with neutropenia (N=66,106) showed that approximately 3% to 12% of these patients, depending on the type of malignancy, experienced VTE during their first hospitalization.1 In a recent health claims database analysis of patients undergoing chemotherapy for solid tumors in the ambulatory setting (N=17,284), VTE NCCN Venous Thromboembolic Disease Clinical Practice Guidelines in Oncology AbstractVenous thromboembolism (VTE) remains a common and life-threatening complication among patients with cancer. Thromboprophylaxis can be used to prevent the occurrence of VTE in patients with cancer who are considered at high risk for developing this complication. Therefore, it is critical to recognize the various risk factors for VTE in patients with cancer. Risk assessment tools are available to help identify patients for whom discussions regarding the potential benefits and risks of thromboprophylaxis would be appropriate. The NCCN Clinical Practice Guidelines in Oncology for VTE provide recommendations on risk evaluation, diagnosis, prevention, and treatment of VTE in patients with cancer. (JNCCN 2013;11:1402-1429 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate. These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

show abstract

“…Furthermore, the risk of wound hematoma after breast and/or axillary surgery can be tripled by the practice of systemic anti-VTE prophylaxis [54]. Andtbacka and colleagues [55] studied this issue in 3898 patients undergoing surgery for breast cancer at the University of Texas M.D. Anderson Cancer Center (with anti-VTE management consisting of early ambulation and compression stockings only) and reported a VTE rate of 0.16%, detected at a median time of 2 weeks after surgery.…”

Section: Venous Thromboembolismmentioning

confidence: 99%

Complications in Breast Surgery

Newman¹,

Sondak²

2007

Surgical Complications

View full text Add to dashboard Cite

The breast is a relatively clean organ comprised of skin, fatty tissue, and mammary glandular elements that have no direct connection to any major body cavity or visceral structures. In the absence of concurrent major reconstruction, breast surgery generally is not accompanied by large-scale fluid shifts, infectious complications, or hemorrhage. Thus, most breast operations are categorized as low-morbidity procedures. Because the breast is the site of the most common cancer afflicting American women, however, a variety of complications can occur in association with diagnostic and multidisciplinary management procedures. Some of these complications are related to the breast itself, and others are associated with axillary staging procedures. This article first addresses some general, nonspecific complications (wound infections, seroma formation, hematoma). It then discusses complications that are specific to particular breast-related procedures: lumpectomy (including both diagnostic open biopsy and breast-conservation therapy for cancer), mastectomy; axillary lymph node dissection (ALND), lymphatic mapping/sentinel lymph node biopsy, and reconstruction. Complications related to reconstruction are discussed in a separate article in this issue. General wound complications related to breast and axillary surgeryBecause it is a peripheral soft tissue organ, many wound complications related to breast procedures are relatively minor and frequently are managed on an outpatient basis. It therefore is difficult to establish accurate incidence rates for these events. As discussed later, however, reported studies

show abstract

Incidence and Prevention of Venous Thromboembolism in Patients Undergoing Breast Cancer Surgery and Treated According to Clinical Pathways

Abstract: VTE following breast cancer surgery is rare in patients who are treated on clinical pathways with mechanical antiembolism devices and early ambulation in the postoperative period. We conclude that systemic VTE prophylaxis is not indicated in this group of patients.

Cited by 85 publications

References 18 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Venous Thromboembolic Disease

Complications in Breast Surgery

Contact Info

Product

Resources

About