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

Putsarat Insin, Nawapas Pookcharoen, Suvanna Asavapiriyanon

Abstract


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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References


White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23 Suppl 1): I4-8.

Tapson VF. Acute pulmonary embolism. The New England journal of medicine. 2008;358(10):1037-52.

White RH, Keenan CR. Effects of race and ethnicity on the incidence of venous thromboembolism. Thrombosis research. 2009;123 Suppl 4: S11-7.

Pruemer J. Prevalence, causes, and impact of cancer-associated thrombosis. American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists. 2005;62(22 Suppl 5): S4-6.

Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. The American journal of medicine. 2004;117(1): 19-25.

Anaya DA, Nathens AB. Thrombosis and coagulation: deep vein thrombosis and pulmonary embolism prophylaxis. The Surgical clinics of North America. 2005;85(6):1163-77, ix-x.

Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl): 338s-400s.

Einstein MH PE, Hartenbach EM Venous thromboembolism prevention in gynecologic cancer surgery: a systemic review. Gynecol Oncol, (2007). ;105, :813-9.

Heidrich H, Konau E, Hesse P. Asymptomatic venous thrombosis in cancer patients--a problem often overlooked. Results of a retrospective and prospective study. VASA Zeitschrift fur Gefasskrankheiten. 2009;38(2):160-6.

Khorana AA FC, Culakova E, et al Frequency, risk factors, and the trends for venous thromboembolism among hospitalized cancer patients. Cancer, (2007). ;110, :239-46.

Khorana AA, McCrae KR. Risk stratification strategies for cancer-associated thrombosis: an update. Thrombosis research. 2014;133 Suppl 2: S35-8.

Blom JW VJ, Oostindier MJ, et al Incidence of venous thrombosis in a large cohort of 66,392 cancer patients: results of a record linkage study. J Thromb Haemost, (2006).4, :529-35.

Prandoni P, Falanga A, Piccioli A. Cancer and venous thromboembolism. The Lancet Oncology. 2005;6(6):401-10.

Young A, Chapman O, Connor C, Poole C, Rose P, Kakkar AK. Thrombosis and cancer. Nature reviews Clinical oncology. 2012;9(8):437-49.

Ailawadi M, Del Priore G. A comparison of thromboembolic prophylaxis in gynecologic oncology patients. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society. 2001;11(5):354-8.

Hong Q ZL, Zhenguo Z, et al Predicting of venous thromboembolism for patients undergoing gynecological surgery. Medicine (Baltimore),. (2015). ;94, :e1653.

Shiota M, Kotani Y, Umemoto M, Tobiume T, Tsuritani M, Shimaoka M, et al. Risk factors for deep-vein thrombosis and pulmonary thromboembolism in the benign ovarian tumor. The Tohoku journal of experimental medicine. 2011;225(1):1-3.

Zhang L, Liu X, Xue Y. Analysis of deep venous thrombosis after Gynecological surgery: A clinical study of 498 cases. Pakistan journal of medical sciences. 2015;31(2):453-6.

Sermsathanasawadi N, Thangrod R, Hongku K, Wongwanit C, Ruangsetakit C, Chinsakchai K, et al. Prevalence of perioperative asymptomatic proximal deep vein thrombosis in Thai gynecologic cancer patients. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2014;97(2):153-8.

Schlesselman. Case-Control Studies: Design, Conduct, Analysis. New York, NY: Oxford University Press. J (1982).

Santoso JT, Evans L, Lambrecht L, Wan J. Deep venous thrombosis in gynecological oncology: incidence and clinical symptoms study. European journal of obstetrics, gynecology, and reproductive biology. 2009;144(2):173-6.

Metcalf RL, Fry DJ, Swindell R, McGurk A, Clamp AR, Jayson GC, et al. Thrombosis in ovarian cancer: a case-control study. British journal of cancer. 2014;110(5):1118-24.

Oranratanaphan S TW, Khemapech N. Incidence and clinical characteristic of venous thromboembolism in gynecologic oncology patients attending King Chulalongkorn Memorial Hospital over a 10-year period. Asian Pac J Cancer Prev. (2015). ; 16,: 6705-9.

Seung CP JW, Soon P, et al The deep vein thrombosis caused by lymphocele after endoscopic extraperitoneal radical prostatectomy and pelvic lymph node dissection. Can Urol Assoc J, . (2011). 5:40-3.

Tollefson MK, Karnes RJ, Rangel L, Carlson R, Boorjian SA. Blood type, lymphadenectomy and blood transfusion predict venous thromboembolic events following radical prostatectomy with pelvic lymphadenectomy. J Urol. 2014;191(3):646-51.

Abu-Rustum NR, Richard S, Wilton A, Lev G, Sonoda Y, Hensley ML, et al. Transfusion utilization during adnexal or peritoneal cancer surgery: effects on symptomatic venous thromboembolism and survival. Gynecologic oncology. 2005;99(2):320-6.




DOI (PDF (FULL TEXT)): http://dx.doi.org/10.22034/APJCC.2018.3.1.11

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