Predictors of venous thromboembolism in patients with primary sarcoma of bone

Kaiser, C; Freehan, Micayla K.; Driscoll, Daniel A.; Schwab, Joseph H.; Bernstein, Karen De Amorim; Lozano-Calderón, Santiago

doi:10.1016/j.suronc.2017.09.007

Cited by 18 publications

(23 citation statements)

References 13 publications

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“…T A B L E 3 Summary of thromboprophylaxis methods in patients with surgically managed sarcoma ASCO recommends patients with active malignancy undergoing surgery be given pharmacologic thromboprophylaxis for at least 10-14 days postoperatively, and in cases of major surgery, this should be extended to 4 weeks. 13 This review found only 17.0% were given pharmacologic thromboprophylaxis, which is much lower than expected considering current guidelines. Both pharmacologic thromboprophylaxis choice and duration varied between studies demonstrating the lack of consensus on how these patients should be managed.…”

Section: Thromboprophylaxis and Vte Ratesmentioning

confidence: 73%

“…10 Despite the potential for increased risk of VTE in surgical oncology patients, current guidelines for postoperative thromboprophylaxis do not address this specific patient population and there is no strong consensus on the most efficient strategy to prevent VTE in musculoskeletal oncology patients. 13,14 Current guidelines are vague, with American Society of Clinical Oncology (ASCO) recommending patients with malignant disease undergoing major surgery be offered either unfractionated heparin or low-molecular-weight heparin (LMWH) for a duration determined on a case-by-case basis. 15 Thrombosis Canada guidelines recommend various oral anticoagulants (OACs) and durations based on the type of orthopedic surgery.…”

mentioning

confidence: 99%

“…18 On the other hand, it has been shown that patients with malignancy on OACs were more likely to experience major bleeding than those without malignancy 19 and that patients with primary sarcoma given OACs had increased wound complications after surgery. 13 Based on previous literature, coupled with studies citing small sample sizes and cohorts that combined patients with sarcoma and those with metastatic bone disease, this systematic review aims to answer the following objectives: (1) What is the VTE rate in patients with bone and soft tissue sarcoma involving the extremities after surgical management? (2) Do VTE rates differ between patients with bone and soft tissue sarcoma of the extremities?…”

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confidence: 99%

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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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Section: Thromboprophylaxis and Vte Ratesmentioning

confidence: 73%

mentioning

confidence: 99%

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confidence: 99%

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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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“…There are few reports about postoperative VTE development in malignant bone and soft tissue tumors [10][11][12][13][14][15][16][17][18][19][20][21]. As large studies occasionally include patients receiving anticoagulant therapy or localization of the upper extremity, we cannot compare the postoperative VTE incidences and risk factors equally.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have indicated that tumor size [14], prosthesis reconstruction [14], chemotherapy [14,15], elderly population [17,18], American Society of Anaesthesiologists grade [17], metastatic disease [17,19], intraoperative oxygen saturation drop [19], higher preoperative white blood cell count [20], post-operative wound complications [20], diabetes mellitus [21], history of VTE [21] and intraoperative blood loss [21] are risk factors for VTE during postoperative management of malignant bone and soft tissue tumors. However, these do not lead to a definite conclusion because the background for the analysis varies.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Diagnosis, and Risk Factors of Venous Thromboembolism after Surgery for Malignant Bone and Soft Tissue Tumor of Lower Extremity

Yoshimura¹,

Ikegami²,

Aoki³

et al. 2018

Int J Phys Med Rehabil

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Objective: This study aimed to prospectively evaluate the incidence, characteristics, and risk factors of venous thromboembolism (VTE) development, and the diagnostic value of blood coagulation markers in patients receiving surgery for malignant bone and soft tissue tumor of lower extremity. Methods:A prospective study of 20 patients who were examined using ultrasonography. Serum soluble fibrin monomer complex (SFMC) and D-dimer were measured in the perioperative period. VTE incidence, VTE development time, change in blood coagulation markers, and effect of each risk factor were evaluated.Results:VTE was found in 8 of 20 patients. Four of these 8 patients had the finding of pulmonary embolism (PE) without symptom. Onset time of VTE was from day 1 to 7 after surgery. The cutoff value of SFMC was <3 µg/mL at any measurement point and D-dimer was approximately 2 µg/mL in receiver operating characteristic analysis. Body mass index was the only significant risk factor. Conclusion: VTE showed high incidence and often occurred in the early period in only physical prophylaxis after surgery. SFMC or D-dimer was not always useful to detect VTE development. With regard to rehabilitation intervention, risk management is required until 1 week after surgery.

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The efficacy and safety of direct oral anticoagulants compared with low‐molecular‐weight heparin for venous thromboembolism prophylaxis after surgical resection of primary lower extremity bone or soft‐tissue sarcoma

LiBrizzi,

Agarwal,

Chiu

et al. 2023

Journal of Surgical Oncology

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IntroductionThe incidence of postoperative venous thromboembolism (VTE) and wound complications is greater after sarcoma resection. We sought to identify differences in postoperative VTE and bleeding complications with direct oral anticoagulants (DOACs) versus low‐molecular‐weight heparin (LMWH) following resection of lower extremity primary bone or soft tissue sarcoma.MethodsWe retrospectively identified 2083 patients from the PearlDiver database who underwent resection of primary bone or soft tissue sarcoma of the lower extremity from January 2010 to October 2021 and prescribed LMWH or DOAC within 90‐days postoperatively. The primary outcomes were comparison of postoperative incidence and odds of deep venous thrombosis (DVT), pulmonary embolism (PE), and bleeding complications within 90‐days following resection.ResultsPatients prescribed DOACs had a greater odds of DVT (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.06–2.41; p = 0.024) and PE (OR: 3.38; 95% CI: 1.96–5.86; p < 0.001) within 90‐days following resection of bone sarcoma when compared with the LMWH cohort. Patients undergoing resection of soft tissue sarcomas also had greater odds DVT (OR: 1.65; 95% CI: 1.09–2.49; p = 0.016) and PE (OR: 2.62; 95% CI: 1.52–4.54; p < 0.001) in the DOAC cohort. There was no difference in the odds of bleeding complications.ConclusionThis study demonstrated an increased incidence and odds of VTE, but not bleeding complications, when using DOACs versus LMWH after primary bone or soft tissue sarcoma resection.Level of EvidenceLevel III.

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Predictors of venous thromboembolism in patients with primary sarcoma of bone

Cited by 18 publications

References 13 publications

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

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

Incidence, Diagnosis, and Risk Factors of Venous Thromboembolism after Surgery for Malignant Bone and Soft Tissue Tumor of Lower Extremity

The efficacy and safety of direct oral anticoagulants compared with low‐molecular‐weight heparin for venous thromboembolism prophylaxis after surgical resection of primary lower extremity bone or soft‐tissue sarcoma

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