Purpose: The purpose of this study was to assess the incidence of venous thromboembolism (VTE) in high-risk surgical oncology patients at a Veterans Affairs institution.
Background: Oncology patients undergoing abdominal or pelvic surgeries are at high-risk of developing postoperativeVTE. Current guidelines published by the American Societyof Clinical Oncology (ASCO), National Comprehensive Cancer Network (NCCN), and American College of Chest Physicians(ACCP) recommend at least 4 weeks of pharmacologic thromboprophylaxis postoperatively in high-risk oncology patients.
Methods: Electronic medical records were utilized to identify oncology patients aged 18 to 89 years undergoing general or urologic surgeries from June 1, 2013 to June 30, 2015. The primary objective was the incidence of VTE up to 30 days postoperatively in patients receiving optimal (OT) (4 weeks of anticoagulation if no contraindications) versus suboptimal (ST) thromboprophylaxis. Secondary objectives included incidence of early (days 0 to 7) and late (days 8 to 30) postoperative VTE, severity of VTE, and hematologic toxicities associated with VTE prophylaxis.
Data Analysis: Logistics regression with an alpha of 0.05 was utilized to analyze the primary outcome. Other outcomes were reported as descriptive statistics.
Results: A total of 167 patients were assessed (136 patients in the ST group and 31 patients in the OT group). There were 4 (2.9%) and 1 (3.2%) VTEs in the ST and OT groups, respectively (OR = 0.10; 95% CI, -2.13 to 2.32; P > 0.05). All VTEs occurred during the late postoperative period. In the ST group, 3 patients had an uncomplicated pulmonary embolism (PE) or deep venous thromboembolism, and 1 patient died due to thromboembolic complications. In the OT group, 1 patient had an uncomplicated PE. There were no significant differences in postoperative bleeding (11.4% versus 14.4%) or thrombocytopenia (45.7% versus 47.4%) in patients receiving pharmacologic versus non-pharmacologic thromboprophylaxis.
Implications: Provision of optimal thromboprophylaxis was low for high-risk surgical oncology patients; however, this was not associated with an increase in VTEs. Use of pharmacologic thromboprophylaxis did not increase rates of bleeding or thrombocytopenia. Education is needed to increase compliance with guideline recommendations for postoperative thromboprophylaxis in high-risk surgical oncology patients at our institution.