Venous thromboembolism prophylaxis in patients undergoing abdominal or pelvic surgery for cancer - A real-world, prospective, observational French study: PReOBS

Introduction: Data on the epidemiology and prevention of venous thromboembolism in patients undergoing abdominal or pelvic cancer surgery in real practice are limited. The primary objective of this observational study was to describe the thromboprophylactic strategy implemented in routine practice. The main secondary objective was to assess the incidence of outcomes. Materials and Methods: Patients admitted to public or private hospitals for abdominal or pelvic cancer surgery were included between November 2009 and November 2010; endoscopic route for surgery was the only exclusion criterion. Study outcomes were recorded at hospital discharge and at routine follow-up (generally 9 +/- 3 weeks). Results: 2380 patients (mean SD age: 66.4 +/- 11.6 years, women: 36.8%) admitted to hospital for abdominal (47.8%), urological (41%), or gynaecological (11.2%) cancer surgery were included in the analysis. Of these, 2179 had data available at study end. Perioperative antithrombotic prophylaxis, consisting mainly of lowmolecular-weight heparin, was given to 99.5% of patients. At hospital discharge, thromboprophylaxiswas continued in 91.7% of patients, 57.4% receiving a 4-6 week prophylaxis. This management strategy was associatedwith an overall venous thromboembolic event rate of 1.9%, 34.7% of events occurring after discharge. Incidences of fatal bleeding, bleeding in a critical organ and bleeding necessitating re-intervention were 0.1%, 0.3% and 1.7%, respectively. Overall mortality was 1.5%. Conclusions: Thromboprophylaxis is routinely used in French patients undergoingmajor cancer surgery. Formore than a third of patients, however, treatment duration did not comply with best-practice recommendations, which might explain the non-negligible rate of thromboembolic complications still observed in this patient population. (C) 2013 Elsevier Ltd. All rights reserved.