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. 2019 Feb;26(1):e106-e110.
doi: 10.3747/co.26.4339. Epub 2019 Feb 1.

Extended venous thromboembolism prophylaxis after abdominopelvic cancer surgery: a retrospective review

M Laureano  1 , M Ebraheem  1 , M Crowther  1
Affiliations

Extended venous thromboembolism prophylaxis after abdominopelvic cancer surgery: a retrospective review

M Laureano et al. Curr Oncol. 2019 Feb.

Abstract

Objective: Extended prophylaxis against venous thromboembolism (vte) after abdominal or pelvic cancer surgery with low molecular weight heparin (lmwh) is recommended by multiple guidelines. The primary objective of the present study was to assess adherence to that guideline recommendation at tertiary care centres within Hamilton Health Sciences (hhs).

Methods: Given that an estimated 70% of the study population would be expected to receive extended prophylaxis, a sample size of 105 patients was calculated. Patients who had undergone abdominal or pelvic surgery for cancer from March 2012 to December 2015 were identified, and data were collected from electronic health records. The primary outcome was prescription of extended vte prophylaxis.

Results: Of 105 patients, only 3 received extended vte prophylaxis. Those 3 patients had serous carcinoma of the uterus, transitional cell carcinoma of the bladder, and cecal cancer. Of the 3 patients, 2 were followed by the thrombosis service while in hospital; none of the other 102 patients received any form of extended vte prophylaxis.

Conclusions: Based on multiple randomized controlled trials, guidelines suggest lmwh prophylaxis for up to 4 weeks after major abdominal or pelvic cancer surgery. Despite those recommendations, postoperative extended vte prophylaxis is not commonly prescribed at hhs facilities. Next steps will include identification of barriers and an examination of how those barriers could be addressed. Failure to use prophylaxis is not consistent with evidence-based guidelines and is placing patients at risk of vte.

Keywords: Extended prophylaxis; cancer-associated thrombosis; low molecular weight heparin.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare the following interests: MC has sat on advisory boards for Octapharma and Bayer; he has participated in study steering committees or other research-related activities for projects involving Daiichi–Sankyo and Bayer; he holds a Career Investigator award from the Heart and Stroke Foundation of Ontario and the Leo Pharma Chair in Thromboembolism Research at McMaster University (income from which is used to support the salary of research employees); his institutions (either or both of McMaster University and St. Joseph’s Healthcare) have received funding for research projects from the Heart and Stroke Foundation of Canada, Leo Pharma, and Bayer for work in which he is involved; he has received funding for preparation of educational materials or presentations (or both) from Alexion, Bristol–Myers Squibb/ Pfizer alliance, Leo Pharma, Bayer, and CSL Behring; he has participated in various medicolegal activities relating to thrombosis, anticoagulant drugs, or other aspects of hematology practice, and those activities are bound by confidentiality arrangements. Further, this declaration is made to the best of MC’s ability, but might be incomplete or contain material errors, given the foibles of human memory. This work was supported by a Regional Medical Associates scholarship to ML. ME has no conflicts to disclose.

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