Rates of Venous Thromboembolism Among Patients with Major Surgery for Cancer

Hammond, Jeff R.; Kozma, Chris M; Hart, James; Nigam, Somesh; Daskiran, Mehmet; Paris, A. M. I.; Maćkowiak, J

doi:10.1245/s10434-011-1723-2

Cited by 35 publications

(19 citation statements)

References 12 publications

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“…Factors related to cancer treatment such as surgery was shown to increase the risk of DVT by 2 to 5 fold, and most of DVT cases occurred within the first 2 week post-surgery. 11,12 In contrast with previous study, this study found that most of DVT cases (88.2%) occurred before initial treatment, and no DVT cases occurred during post-operative hospitalization with mean of length of stay of 8.8 days. Obstruction of the venous return of the lower extremities due to massive tumor within pelvic cavity, massive ascites leading to intravascular hypovolemic, massive cancer cells before any treatment which release massive tissue factor are the possible explanation for DVT occurrence before treatment.…”

Section: Discussioncontrasting

confidence: 89%

Clinical and Laboratory Predictors of Deep Vein Thrombosis in Ovarian Malignant Tumor

Kusuma¹,

Sitorus²

2017

Indones J Obstet Gynecol

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Objective: To investigate the clinical and laboratory predictors of symptomatic deep vein thrombosis (DVT) in ovarian malignant tumor. Methods: One hundred sixteen patients with suspected ovarian malignant tumor were recruited. Age, body mass index (BMI); D-dimer, fibrinogen, thrombocyte level, comorbid, tumor diameter, staging, distant metastasis, ascites, histopathology, length of surgery, blood loss and transfusion were recorded. Results: Incidence of symptomatic DVT was 16.5% and 88.2% cases occurred before surgery. No case of symptomatic DVT during postoperative care was found. Predictors of DVT were distant metastasis (OR 28.99; 95% CI 3.83-219.52, BMI ≥ 22.7 kg/m2 (OR 15.52, 95% CI 2.24-107.37), D-Dimer ≥ 1700 mg/ml (OR 13.30, 95% CI 2.40- 73.84), advanced stage (OR 6.66; 95% CI 1.05-42.27), epithelial tumor (OR 6.5; 95% CI 0.34-125.75), tumor’s diameter ≥ 18.25 cm (OR 2.36, 95% CI 0.48-11.54), and comorbidity (OR 2.49, 95% CI 0.53-11.66). Prediction score of DVT were score 3 for distant metastasis, BMI ≥ 22.7 kg/m2, D-Dimer ≥ 1700 mg/ml, score 2 for advanced stage, score 1 for tumor diameter ≥ 18.25 cm, comorbid, epithelial tumor and score 0 for the absence of variables or its value less than the cut off. Total score ≥ 8 of 14 is the least score which has a good predictive value for DVT with AUC 0.92, 95% CI 0.86-0.92, probability 86.46%. Conclusion: Distant metastasis and D-dimer are independently associated with the development of DVT in ovarian malignant tumor. [Indones J Obstet Gynecol 2017; 5-3: 180-184] Keywords: deep vein thrombosis, D-dimer, ovarian malignant, tumor predictor

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Section: Discussioncontrasting

confidence: 89%

Clinical and Laboratory Predictors of Deep Vein Thrombosis in Ovarian Malignant Tumor

Kusuma¹,

Sitorus²

2017

Indones J Obstet Gynecol

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“…The results of the present study can be judged to be comparable to previous epidemiological surveys in western countries (11,18), and it is expected that postoperative VTE prevention will become an important part of risk management even in Japan. According to large-scale studies, the proportion of perioperative asymptomatic DVT treated without anticoagulant therapy or with elastic stockings alone ranged from 14.5 to 23.7% (17,19).…”

Section: Discussionsupporting

confidence: 85%

Efficacy and Safety of Enoxaparin for Prophylaxis of Postoperative Venous Thromboembolism After Esophagectomy: A Single-center Prospective Randomized Controlled Phase II Study

et al. 2019

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Background/Aim: This study aimed to assess whether low-molecular-weight heparin (LMWH) is effective and safe in preventing postoperative venous thromboembolism (VTE) in patients undergoing esophageal cancer surgery. Patients and Methods: In this single-institution, prospective, randomized trial, 73 patients with esophageal cancer undergoing esophagectomy were randomly divided into the enoxaparin group (E group) and intermittent pneumatic compression group (I group). The primary endpoint was efficacy of enoxaparin, and secondary endpoints were evidence of bleeding and serum anti-Xa activity in the E group. Results: The E group comprised 42 patients and the I group comprised 31 patients. Deep vein thrombosis was observed in 0 (0%) patients in the E group and 7 (22.6%) patients in the I group (p=0.002). Soluble fibrin monomer complex was significantly lower in the E versus I group on day 8 (p<0.001). D-dimer was significantly lower in the E versus I group on days 2, 8, and 15 (p=0.008, p<0.001, p<0.001, respectively). Conclusion: VTE was significantly reduced by using enoxaparin. Venous thromboembolism (VTE) is the second leading cause of death in cancer patients receiving outpatient chemotherapy (1). As represented by Trousseau's syndrome, multiple pathophysiologic mechanisms contribute to the hypercoagulability associated with cancer (2). The Japan VTE Treatment Registry revealed the maximal risk factor for VTE to be cancer (3). Major surgery for cancer located in the abdomen or chest is associated with a high incidence of VTE, as the major postoperative complication, including deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) (4). According to previous reports, the incidence of symptomatic VTE after esophagectomy is reported to range from 2.9 to 3.8%, (5, 6), whereas that of asymptomatic VTE after esophagectomy ranges from 5.9 to 23.3% (7-9). Thus, the prevalence of asymptomatic VTE is not small after esophageal cancer surgery, and occasionally, unfortunate outcomes can occur; thus, prevention of VTE is very important. The use of low-molecular-weight heparin (LMWH) was recommended to prevent VTE after cancer surgery (10). Lee et al. reported that in patients with cancer and acute VTE, LMWH was more effective than an oral anticoagulant in reducing the risk of recurrent VTE, without increasing the risk of bleeding (11). However, an optimal strategy of thromboprophylaxis for esophagectomy has not been formulated, and to the best of our knowledge, there are no reports comparing the effects of LMWH through randomized controlled trials (RCTs). Enoxaparin is a LMWH that functions as an anticoagulant agent by forming a complex with antithrombin 3 (AT-III) and promoting AT-III activity. The evidence for enoxaparin in orthopedic, gynecologic malignancy and abdominal or pelvic malignancy has already been established (12-14). In 2615 This article is freely accessible online.

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“…Besides, the risk of VTE varies among different cancers, which is especially high for malignant esophagus neoplasm resection. The patients with esophagus cancer were often exposed to related risk factors, resulting in high risk of VTE that could descend up to 13.2% (12)(13)(14). Hence, the current administration of heparin intending to solve the issue of VTE prophylaxis for the malignant neoplasm patients who were ready to undergo surgery was not sufficient, especially for thoracic surgery.…”

Section: Discussionmentioning

confidence: 99%

The influence of heparin on coagulation function of patients undergoing video-assisted major thoracic surgery

Alai

Deng

et al. 2018

J. Thorac. Dis.

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Background: Venous thromboembolism (VTE) remains a common complication after major thoracic surgery, especially resection of lung or esophagus cancer. This trial aims to explore the influence of preoperative usage of heparin on coagulation function of patients treated with video-assisted major thoracic Conclusions: All patients underwent video-assisted major thoracic surgery with preoperative use of heparin, there were significant differences in coagulation function after operation. However, mean values of all coagulation parameters stayed normal range clinically. In a word, the method showed no influence on coagulation function clinically.

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Rates of Venous Thromboembolism Among Patients with Major Surgery for Cancer

Cited by 35 publications

References 12 publications

Clinical and Laboratory Predictors of Deep Vein Thrombosis in Ovarian Malignant Tumor

Clinical and Laboratory Predictors of Deep Vein Thrombosis in Ovarian Malignant Tumor

Efficacy and Safety of Enoxaparin for Prophylaxis of Postoperative Venous Thromboembolism After Esophagectomy: A Single-center Prospective Randomized Controlled Phase II Study

The influence of heparin on coagulation function of patients undergoing video-assisted major thoracic surgery

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