Key clinical point:
Major finding: Eighty-four percent of VTEs were diagnosed before or after the 6-week postoperative window, and 31% developed during chemotherapy.
Study details: Retrospective study of 431 women diagnosed with uterine serous carcinoma between 1999 and 2016 at one center in New York.
Disclosures: Dr. Gressel and his coauthors reported no conflicts of interest. The study was supported by the National Institutes of Health and a grant from the National Center for Advancing Translational Science.
Gressel GM et al. Obstet Gynecol. 2018 Oct 5;132:1130-6.
It has been reported in previous literature that the risk of developing VTE is typically within 48 hours of surgical staging, and guidelines have focused on risk factors to identify patients needing extended thromboprophylaxis after surgery. Therefore, Gressel et al. set forth to identify risk factors and timing of development of VTE in women with uterine serous carcinoma.
The study retrospectively evaluated 413 women with uterine serous cancer from 1999 to 2016. Of these, 70 women (about 17%) were diagnosed with a VTE. There was not a statistically significant association between age, body mass index, race, or surgical approach with risk of VTE. However, stage and/or having two or more medical comorbidities were significant. Compared with stage I patients, stage III and IV patients had a 2.6- and fourfold increase in risk, respectively. Not surprisingly, hypertension and cardiovascular disease (CVD) were independently associated with risk of VTE development; odds ratio 2.97 and 1.87, respectively. Interestingly, in the women diagnosed with VTE, 84% were outside the 6-week postoperative period and 31% occurred during chemotherapy treatment. The median time to develop VTE was 13.2 months and occurred sooner in women with advanced stage.
In this study, the majority of patients developed a VTE outside of the standard 28-day thromboprophylaxis window. This finding suggests that there is a subset of patients who would benefit from longer duration of thromboprophylaxis. Perhaps patients with hypertension, CVD, and/or advanced stage malignancy would benefit from thromboprophylaxis throughout their treatment. Based on the data presented, at this time, we cannot recommend treating patients with the above risk factors during the entirety of their care. Although further studies and even a nomogram may help determine who is likely to benefit from prolonged prophylaxis, it is unknown if doing so would result in significant decreased morbidity or increased adverse events (e.g. bleeding, thrombocytopenia). However, this should remain a topic for further evaluation and providers should remain vigilant for prevention and diagnosis of VTE in at-risk patients by adhering to validated risk assessment tools and clinical evaluation.
Antonio Castaneda, MD, is a gynecologic oncology fellow at The Ohio State University in Columbus. He said he had no relevant financial disclosures.