Venous thromboembolism in patients with cancer undergoing surgical exploration

Ruff, Samantha M.; Weber, Kathryn T.; Khader, Adam; Conte, Charles; Kadison, Alan S.; Sullivan, J.; Wang, John; Zaidi, Raza; Deutsch, Gary B.

doi:10.1007/s11239-018-1774-3

Cited by 10 publications

(13 citation statements)

References 40 publications

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“…In one ovarian cancer cohort (n = 13,031), person-time incidence rate of VTE decreased over 2 years after cancer diagnosis; in another ovarian cancer cohort (n = 1,989), the absolute rate of VTE decreased over a median 2 years [7,17]. Other cohort studies have reported that incidence of VTE in women with gynecologic cancers decreased over time for 30 days (n = 175) and 90 days (n = 4,158) from cancer surgery [38,39]. In one cancer cohort with claims database analysis (n = 17,284), the incidence of VTE decreased over time during the 12 months after initiation of chemotherapy [28].…”

Section: Discussionmentioning

confidence: 94%

Incidence and risk of venous thromboembolism according to primary treatment in women with ovarian cancer: A retrospective cohort study

et al. 2021

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Objective This study aimed to investigate incidence and risk for venous thromboembolism (VTE) according to primary treatment in women with ovarian cancer. Methods We selected 26,863 women newly diagnosed with ovarian cancer between 2009 and 2018 from the Korean Health Insurance Review and Assessment Service databases. During the total follow-up period and the first six months after initiation of primary treatments, incidence and risk of VTE were evaluated according to primary treatment as no treatment, surgery, radiotherapy, or chemotherapy. Results The mean follow-up period was 1285.5±6 days. The VTE incidence was highest in women who underwent chemotherapy (306 per 10,000 women). Among women who underwent surgery, VTE was highest in surgery with neoadjuvant chemotherapy (536 per 10,000 women), followed by surgery with adjuvant chemotherapy (360 per 10,000 women) and surgery alone (132 per 10,000 women). During the first 12 months, monthly incidence of VTE decreased. Compared with women with no treatment, risk of VTE significantly increased in women undergoing chemotherapy (HR 1.297; 95% CI, 1.08–1.557; P = 0.005) during the total follow-up period and decreased in women undergoing surgery (HR 0.557; 95% CI, 0.401–0.775; P<0.001) and radiotherapy (HR 0.289; 95% CI, 0.119–0.701; P = 0.006) during the first six months. Among women who underwent surgery, VTE risk significantly increased in surgery with neoadjuvant chemotherapy (HR 4.848; 95% CI, 1.86–12.632; P = 0.001) followed by surgery with adjuvant chemotherapy (HR 2.807; 95% CI, 1.757–4.485; P<0.001) compared with surgery alone during the total follow-up period and in surgery with neoadjuvant chemotherapy (HR 4.223; 95% CI, 1.37–13.022; P = 0.012) during the first six months. Conclusions In this large Korean cohort study, incidence and risk of VTE were highest in women with ovarian cancer who underwent chemotherapy and surgery with neoadjuvant chemotherapy as a primary cancer treatment. Incidence of VTE decreased over time.

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Section: Discussionmentioning

confidence: 94%

Incidence and risk of venous thromboembolism according to primary treatment in women with ovarian cancer: A retrospective cohort study

et al. 2021

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“…In one cohort study, the absolute rate of VTE in women with endometrial cancer ( n = 1958) decreased over time after cancer diagnosis [ 26 ]. In another two cohort studies, the incidence of VTE decreased over time for 30 ( n = 175) and 90 days ( n = 4158) following gynecologic cancer surgery [ 27 , 28 ], and in a fourth cancer cohort study conducted on a claims database ( n = 17,284), the incidence of VTE decreased over time during the 12 months following the initiation of chemotherapy [ 18 ]. Similarly, we found that in the no treatment, surgery, and hormone therapy groups, the incidence of VTE decreased with time during the first year after primary cancer treatment initiation.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk of venous thromboembolism according to primary treatment type in women with endometrial cancer: a population-based study

et al. 2021

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Background Current prophylaxes and treatments for venous thromboembolism (VTE) in women with gynecologic cancer are mainly guided by studies on solid cancers because studies in gynecologic cancer did not provide sufficient data. Large-scale studies evaluating the incidence and risk of VTE according to therapeutic modality may guide prophylaxis and treatment of VTE in gynecologic cancer. This study was performed to determine the incidence and risk of VTE according to primary treatment type in Korean women with endometrial cancer. Methods We selected 26,256 women newly diagnosed with endometrial cancer between 2009 and 2018 from the Korean Health Insurance Review and Assessment Service database. During the total follow-up period and first six months after primary treatments initiation, the incidence and risk of VTE were evaluated according to primary treatment type, that is, no treatment, surgery, radiotherapy, chemotherapy, or hormone therapy. Results VTE occurred in 136 per 10,000 women during the total follow-up period and in 54 per 10,000 women during the first six months with the highest frequency in women that underwent chemotherapy. During the first year, the monthly incidence of VTE decreased with time among women that underwent no treatment, surgery, or hormone therapy and remained unchanged in those that received radiotherapy or chemotherapy. Compared with women that received no treatment, VTE risk, especially of PE significantly increased in women that underwent chemotherapy (VTE: hazard ratio (HR), 2.334; 95% CI, 1.38–3.949; P = 0.002) (PE: HR, 2.742; 95% CI, 1.424–5.278; P = 0.003) or hormone therapy (VTE: HR, 2.073; 95% CI, 1.356–3.17; P = 0.001) (PE: HR, 2.086; 95% CI, 1.19–3.657; P = 0.01) during the total follow-up period and women that underwent only chemotherapy during the first six months (VTE: HR, 2.532; 95% CI, 1.291–4.966; P = 0.007) (PE: HR, 3.366; 95% CI, 1.496–7.576; P = 0.003). Conclusions In this cohort study, the incidence and risk of VTE were highest in women with endometrial cancer that underwent chemotherapy as a primary treatment. Notably, the incidence of VTE decreased over time in women that received no treatment, surgery, or hormone therapy. This study can help guide therapies for prophylaxis and treatment of VTE in women with endometrial cancer.

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“…29 Research has indicated that when co-existing risk factors such as gastric, pancreatic, or metastatic cancer; sepsis; or congestive heart failure are present, cancer patients undergoing surgery are at an increased risk of thrombosis within 30 days after surgery, approximately one-third of which occur after discharge, suggesting that further research is needed to determine the most reasonable duration of postoperative VTE prophylaxis in tumor patients. 32 A recent study revealed that in tumor patients who underwent major abdominal surgery and prolonged anticoagulation for four weeks after surgery, the VTE risk was reduced by 91%. 33 This finding supports the current guideline suggestion; when cancer patients undergo major operations such as abdominal and pelvic surgery, anticoagulation is recommended to be extended for four weeks.…”

Section: Thromboprophylaxis In Cancer Patientsmentioning

confidence: 99%

Progress in the study of cancer-associated venous thromboembolism

Yao

2020

Vascular

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Objective Venous thromboembolism is a major cause of morbidity, mortality, and increased medical costs in tumor patients. In the current review, we summarize the progress made in the study of cancer-associated venous thromboembolism. Methods By searching cancer-associated venous thromboembolism-related literature on PubMed, the epidemiology, pathological mechanisms, risk factors, risk prediction models, and prevention and treatment of cancer-associated venous thromboembolism were reviewed. Results The pathophysiological mechanisms of cancer-associated venous thromboembolism are multifactorial. Various blood cell counts (such as platelets and white blood cells) and biomarkers (such as D-dimer and sP-selectin) were considered predictors of thrombosis in cancer patients and were incorporated into the venous thromboembolism risk stratification models. Thromboprophylaxis is currently recommended for all hospitalized cancer patients. In addition, outpatient thromboprophylaxis can be used for selected high-risk patients. Low-molecular-weight heparin was the preferred treatment for cancer-associated venous thromboembolism, but some issues arose in the long-term treatment. In this case, direct oral anticoagulants were a treatment option for tumor patients. The efficacy of direct oral anticoagulant in treating cancer patients is not inferior to low-molecular-weight heparin, but is associated with a higher risk of bleeding. Therefore, there were concerns regarding their safety. Conclusion Since thrombocytopenia, thrombosis recurrence, and bleeding are common in tumor patients, the selection of anticoagulants in this circumstance is a considerable challenge for clinicians.

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Venous thromboembolism in patients with cancer undergoing surgical exploration

Cited by 10 publications

References 40 publications

Incidence and risk of venous thromboembolism according to primary treatment in women with ovarian cancer: A retrospective cohort study

Incidence and risk of venous thromboembolism according to primary treatment in women with ovarian cancer: A retrospective cohort study

Incidence and risk of venous thromboembolism according to primary treatment type in women with endometrial cancer: a population-based study

Progress in the study of cancer-associated venous thromboembolism

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