Prevalence and Predictors of Preoperative Venous Thromboembolism in Asymptomatic Patients Undergoing Major Oncologic Surgery

  • Melanie L. Gainsbury
  • Jennifer Erdrich
  • Dani Taubman
  • James Mirocha
  • Nicholas Manguso
  • Farin Amersi
  • Allan W. Silberman
Gastrointestinal Oncology
  • 45 Downloads

Abstract

Background

Postoperative venous thromboembolism (VTE) is a leading cause of in-hospital mortality for cancer patients; however, the prevalence of preoperative VTE remains unclear.

Objective

The aim of this study was to evaluate the prevalence and risk factors associated with preoperative VTE in asymptomatic patients undergoing major oncologic surgery.

Methods

Retrospective analysis of 346 patients identified from our prospectively maintained database of patients undergoing abdominopelvic oncologic surgery from 2009 to 2016.

Results

The prevalence of preoperative VTE found on screening venous duplex scan was 10.1%. Patients with a history of prior VTE were more likely to have a preoperative deep vein thrombosis (DVT) versus those with no prior VTE (42.9% vs. 4.5%, p < 0.01). Relative risk for prior VTE was 8.2 [95% confidence interval (CI) 4.7–14.3]. Older age was also associated with preoperative VTE. Regression modeling determined that patients were 1.24-fold as likely to have a preoperative DVT for every 5-year increase in age (relative risk 1.24, 95% CI 1.09–1.42). Patients with preoperative DVT were more likely to have been diagnosed with sepsis 1 month prior to surgery (8.6% vs. 1.6%, p = 0.04). There were no postoperative pulmonary emboli. The overall postoperative complication rate was higher in those with a preoperative DVT (25.7% vs. 13.2%, p = 0.071).

Conclusion

Asymptomatic patients undergoing major oncologic surgery have a 10.1% prevalence of preoperative DVT. Increasing age, recent diagnosis of sepsis, and a history of prior VTE are significantly associated with preoperative DVTs. This suggests high-risk oncologic patients may benefit from screening lower extremity venous duplex ultrasound prior to Surgery.

Notes

Acknowledgment

Supported in part by the Robert J. and Suzanne Gottlieb and Dr. Jerry H. Buss Endowments in Surgical Oncology, and the Surgical Oncology Education and Research Fund, at Cedars-Sinai Medical Center.

References

  1. 1.
    Fuentes HE, Tafur AJ, Caprini JA. Cancer-associated thrombosis. Dis Mon. 2016;62:121–58.CrossRefPubMedGoogle Scholar
  2. 2.
    Alikhan R, Peters F, Wilmott R, Cohen AT. Fatal pulmonary embolism in hospitalized patients: a necropsy review. J Clin Pathol. 2004;57(12):1254–57.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Trinh VQ, Karakiewicz PI, Sammon J, et al. Venous thromboembolism after major cancer surgery: temporal trends and patterns of care. JAMA Surg. 2014;149(1):43–49.CrossRefPubMedGoogle Scholar
  4. 4.
    Kakkar AK, Haas S, Wolf H, Encke A. Evaluation of perioperative fatal pulmonary embolism and death in cancer surgical patients: the MC-4 cancer substudy. Thromb Haemost. 2005;94(4):867–71.PubMedGoogle Scholar
  5. 5.
    Spyropoulos AC, Hurley JS, Ciesla GN, de Lissvoy G. Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin. Chest. 2002;122(1):108–114CrossRefPubMedGoogle Scholar
  6. 6.
    Hashimoto D, Nakagawa S, Umezaki M, et al. Efficacy and safety of post-operative anticoagulation prophylaxis in patients undergoing pancreatic surgery: a prospective trial and a literature review. Pancreatology. 2017;17:464–70.CrossRefPubMedGoogle Scholar
  7. 7.
    Connelly C, Van PY, Hart KD, et al. Thromboelastography-based dosing of enoxaparin for thromboprophylaxis in trauma and surgical patients: a randomized clinical trial. JAMA Sur. 2016; 151(10):e162069.CrossRefGoogle Scholar
  8. 8.
    Horri Y, Yoshimura N, Hori Y, et al. Correlation between the site of pulmonary embolus and the extent of deep venous thrombosis: evaluation by computerized tomography pulmonary angiography and computerized tomography venography. Jpn J Radiol 2011;29(3):171–76.CrossRefGoogle Scholar
  9. 9.
    Nitta D, Mitani H, Ishimura R, et al. Deep venous thrombosis risk stratification. Int H J 2013;54(3):166–70.CrossRefGoogle Scholar
  10. 10.
    Khorana AA, Francis CW, Culakova E, Kuderer NM, et al. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer. 2007;110:2339–46.CrossRefPubMedGoogle Scholar
  11. 11.
    Bellini G, Teng A, Kotecha N, Sutton E, et al. The identification of risk factors for venous thromboembolism in gastrointestinal oncologic surgery. J Surg Res. 2016;205:279–85.CrossRefPubMedGoogle Scholar
  12. 12.
    Heit JA, Mohr DN, Silverstein MD, Petterson TM, et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med. 2000;160:761–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Prandoni P, Lensing AW, Piccioli A, Bernardi E, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002;100:3484–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Kroger K, Weiland D, Ose C, Neumann N, et al. Risk factors for venous thromboembolic events in cancer patients, Ann Oncol. 2006;17:297–303.CrossRefPubMedGoogle Scholar
  15. 15.
    Louzada ML, Carrier M, Lazo-Langner A, Dao V, et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation. 2012;126:448–54.CrossRefPubMedGoogle Scholar
  16. 16.
    Hanify JM, Dupree LH, Johnson DW, Ferreira JA. Failure of chemical thromboprophylaxis in critically ill medical and surgical patients with sepsis. J Crit Care. 2017;37:206–10.CrossRefPubMedGoogle Scholar
  17. 17.
    De Martino RR, Goodney PP, Spangler EL, et al. Variation in thromboembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg. 2012;55(4):1035–40.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Chew HK, Wun T, Harvey D, Zhou H, et al. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166:458–64.CrossRefPubMedGoogle Scholar
  19. 19.
    Sallah S, Wan JY, Nguyen NP. Venous thrombosis in patients with solid tumors: determination of frequency and characteristics. Thromb Haemost. 2002;87:575–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Riedl JM, Posch F, Bezan A, Szkandera J, et al. Patterns of venous thromboembolism risk in patients with localized colorectal cancer undergoing adjuvant chemotherapy or active surveillance: an observational cohort study. BMC Cancer. 2017;17:415.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Konigsbrugge O, Pabinger I, Cihen A. Risk factors for venous thromboembolism in cancer: novel findings from the Vienna Cancer and Thrombosis Stusy (CATS). Thromb Res. 2014;133(S2):S39-43.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Melanie L. Gainsbury
    • 1
  • Jennifer Erdrich
    • 1
  • Dani Taubman
    • 1
  • James Mirocha
    • 2
  • Nicholas Manguso
    • 1
  • Farin Amersi
    • 1
  • Allan W. Silberman
    • 1
  1. 1.Department of Surgery, Division of Surgical OncologyCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Biostatistics Core, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical CenterLos AngelesUSA

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