Risk Factor of Deep Vein Thrombosis in Gynecologic Cancer Patients at Rajavithi Hospital.

Putsarat Insin, Nawapas Pookcharoen, Suvanna Asavapiriyanon


Background: Venous thromboembolism (VTE), that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant complication after major pelvic surgery and potentially lethal disease in
gynecologic cancer patients. However, its incidence and associated risk factors have not been well established. Objectives: To evaluate risk factors that may be associated with deep vein thrombosis (DVT) in gynecologic
cancer patients. Materials and methods: This retrospective case-control study included patients who diagnosed with gynecologic cancer with or without DVT between January 2002 and December 2016 at Rajavithi Hospital. The presence of DVT was confirmed by either color Doppler ultrasonography or computed tomography scan.Patient’s demographic data, type, and stage of cancer, including treatment modalities were compared. Univariate analysis and multivariate logistic regression analysis were analyzed to calculate odds ratios (OR) and determine independent risk factors for DVT. Results: Over 14 years periods, 242 patients with DVT were identified in a total 8476 gynecologic cancer patients. The incidence of DVT was 2.85% in this patient setting. Complete data were available in 468 patients, 156 (33.3%) cases with DVT diagnosed were compared with 312 (66.7%) controls without DVT. Among patients with DVT, the median time to DVT diagnosis was 4 months (IQR 2-12 months) after diagnosis of cancer, most of the cases (89.5%) were symptomatic DVT, and a half of them (49%) were detected in ovarian cancer. In a multivariate analysis, 3 significant predictors of developing DVT were identified: advanced-stage cancer (OR 7.22; 95%CI 4.62-11.28, p<0.001), patient undergoing lymphadenectomy (OR 1.90; 95%CI 1.21-2.98, p=0.005), and patient with massive operative blood loss (≥1500 ml; OR 2.09; 95%CI 1.12-3.91, p=0.021). Conclusions: Awareness of DVT is the best way to prevent the venous thromboembolism. Therefore, an appropriate prophylaxis and closed monitoring of gynecologic cancer patients with advanced-stage
cancer, undergoing lymphadenectomy, and massive operative blood loss should be mandatory to against thromboembolism complications.

Keywords: Deep vein thrombosis-venous thromboembolism- gynecologic cancer- risk factors

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DOI (PDF (FULL TEXT)): http://dx.doi.org/10.31557/APJCC.2018.3.1.5


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