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Past
Coagulopathy and changes in coagulation biomarkers after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is recognized but few details have been studied;1 however, high plasma D-dimer on postoperative day 3 was a risk factor for postoperative venous thromboembolism (VTE) following gynecological cancer surgery.2 The reported risk for postoperative VTEs in patients with peritoneal surface malignancy is estimated as 5.6% within 60 days after surgery.3 The aim of this study was to investigate postoperative changes in coagulation biomarkers and their predictive ability for VTE.
Present
The study revealed that the 6% incidence rate of symptomatic VTE within 6 months of CRS and HIPEC was similar to comparable abdominal cancer surgeries. Furthermore, the study results revealed that residual tumor at the completion of surgery, as well as elevated D-dimer on day 2, were independent risk factors for postoperative VTE.
Future
D-dimer on day 2 and incomplete cytoreduction of CC2–3 may be useful clinical markers to identify patients at higher risk for VTE after surgery; this could identify patients in need of prolonged prophylaxis. Further research on thromboprophylaxis and on changes in post-HIPEC coagulation biomarkers is needed, particularly research investigating whether clinically relevant cut-off values for D-dimer may exist.
References
Dranichnikov P, Mahteme H, Cashin PH, et al. Coagulopathy and Venous Thromboembolic Events Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol. 2021. https://doi.org/10.1245/s10434-021-09941-9
Kodama J, Seki N, Masahiro S, et al. D-dimer level as a risk factor for postoperative venous thromboembolism in Japanese women with gynecologic cancer. Ann Oncol. 2010;21(8):1651–6.
Khan S, Kelly KJ, Veerapong J, Lowy AM, Baumgartner JM. Incidence, Risk Factors, and Prevention Strategies for Venous Thromboembolism after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol. 2019;26(7):2276–84.
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Dranichnikov, P. ASO Author Reflections: Changes in Coagulation Biomarkers and the Risk for Venous Thromboembolism After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 28, 7783 (2021). https://doi.org/10.1245/s10434-021-09960-6
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DOI: https://doi.org/10.1245/s10434-021-09960-6