Risk of venous thromboembolism and bleeding after major surgery for ovarian cancer: standard in-hospital versus extended duration of thromboprophylaxis

被引：7

作者：

Wiegers, Hanke M. G. ^{[1
,2
,8
]}

Schaafsma, Mirte ^{[3
,4
]}

Guman, Noori A. M. ^{[1
,2
]}

Zelisse, Hein S.

Mulder, Frits I. ^{[1
,2
,5
]}

Middeldorp, Saskia ^{[6
]}

van Es, Nick ^{[1
,2
]}

Mom, Constantijne H. ^{[7
]}

机构：

[1] Univ Amsterdam, Vasc Med, Amsterdam UMC, Amsterdam, Netherlands

[2] Amsterdam Cardiovasc Sci Pulm Hypertens & Thrombo, Amsterdam, Netherlands

[3] Netherlands Canc Inst, Ctr Gynaecol Oncol Amsterdam, Dept Gynaecol Oncol, Antoni Leeuwenhoek, Amsterdam, Netherlands

[4] Univ Amsterdam, Canc Ctr Amsterdam, Dept Pathol, Amsterdam UMC, Amsterdam, Netherlands

[5] Tergooi Med Ctr, Dept Internal Med, Hilversum, Netherlands

[6] Radboud Univ Nijmegen, Med Ctr, Dept Internal Med, Nijmegen, Netherlands

[7] Univ Amsterdam, Canc Ctr Amsterdam, Dept Gynaecol Oncol, Amsterdam UMC, Amsterdam, Netherlands

[8] Univ Amsterdam, Dept Vasc Med, Amsterdam UMC, Amsterdam Cardiovasc Sci, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands

来源：

JOURNAL OF THROMBOSIS AND HAEMOSTASIS | 2023年 / 21卷 / 02期

关键词：

haemostasis; neoplasms; thrombosis; venous thromboembolism; women; PROPHYLAXIS; PREVENTION; ANTICOAGULANTS;

D O I：

10.1016/j.jtha.2022.11.017

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Venous thromboembolism (VTE) is a frequent complication in patients with ovarian cancer after major surgery. Based on limited data, international guidelines recommend extended thromboprophylaxis for up to 28 days. Objectives: To assess the incidence of VTE and bleeding within 30 days following major surgery in patients with ovarian cancer and to evaluate the association between VTE and thromboprophylaxis duration. Methods: This was a single-center, retrospective, "before-after" cohort study in patients with ovarian cancer undergoing major surgery. Before July 2019, the local protocol mandated a standard course of thromboprophylaxis during hospital stay only. From July 2019 onward, patients received extended thromboprophylaxis for 28 days. The cumulative incidences of VTE and major bleeding within 30 days after surgery were estimated using the Kaplan-Meier method, with 95% confidence intervals (CIs). Cox regression analysis was performed to evaluate the association between thromboprophylaxis duration and VTE incidence. Results: Between January 2018 and December 2020, 250 women were included, of which 118 (47.2%) received extended and 132 (52.8%) standard thromboprophylaxis. During follow-up, 12 patients developed VTE (cumulative incidence, 4.8%; 95% CI, 2.1-7.4) and 2 major bleeding (cumulative incidence 0.8%; 95% CI, 0.0-1.9). Compared with standard thromboprophylaxis, VTE incidence was numerically lower with extended duration of thromboprophylaxis (5/118 [4.2%] vs 7/132 [5.3%]) but not significantly different (hazard ratio, 0.80; 95% CI, 0.25-2.52). The risk of major bleeding was similar in both groups (1/118 [0.8%] vs 1/132 [0.8%]; hazard ratio, 1.12; 95% CI, 0.07-17.89). Conclusions: The cumulative VTE incidence in patients with ovarian cancer following major surgery was considerable. Extended thromboprophylaxis was safe and associated with a numerically lower risk of VTE but not significantly different.

引用

页码：294 / 302

页数：9