Anticoagulation outcomes in patients with venous thromboembolism following Whipple surgery for pancreatic cancer: Single center experience.

Abstract

e16255 Background: Venous thromboembolism (VTE) is a common complication in patients with pancreatic cancer (PC). Incidence of major bleeding and clinically relevant non-major bleeding is 14%-20% in patients with cancer who receive anticoagulation therapy (AT). Whipple procedure is a complex surgical intervention offering potential cure in patients with resectable PC; however, surgery can affect drug absorption, which may reduce effectiveness of AT or exacerbate drug related adverse events. Our aim was to assess incidence of bleeding in PC patients who had whipple procedure with subsequent VTE. Methods: Retrospective analysis of medical records for all adult patients with PC who underwent whipple procedure and developed VTE (between July 1, 2010, and July 1, 2020) at Henry Ford Hospital was performed. Multiple variables and outcomes were analyzed by two-group comparisons, univariate analysis, and Cox regression. Results: A total of 32 patients were included in the analysis. The mean (standard deviation [SD]) age was 67.4 (11 y) years, 16 (50%) patients were men, and 16 (50%) were women, (20 [63%] White; 11 [34%] Black; 1 [3%] Asian). The median Khorana score was 3 (range, 2–4). Of the 32 patients, 6 (19%) had upper extremity VTE, 11 (34%) had lower extremity VTE, 10 (31%) had a pulmonary embolism, 7 (22%) had intra-abdominal VTE, and 7 (22%) had recurrent VTE. All patients with upper extremity VTE had a peripherally inserted central catheter (PICC) or a venous port at the time of VTE diagnosis. Most of the patients (28 or 88%) received AT. Whereas 13 (41%) patients had at least one bleeding episode, 19 (59%) had no bleeding. Twenty-two (68%) patients did not need PRBC transfusion, while 4 (13%) patients required > 4 units packed red blood cell transfusion. No significant association between bleeding and AT was observed ( p = .590). Patients with a bleeding event had lower hemoglobin levels ( p = .030) and were more likely to receive blood transfusion ( p = .005). Cox regression analysis did not show patient age, ethnicity, type of AT used, recurrent VTE, and neoadjuvant chemotherapy treatment to be significantly associated with bleeding or death. A total of 14 (44%) patients were alive at the time of analysis. Conclusions: In patients with PC and VTE who received AT after whipple procedure, the incidence of bleeding was higher than what has been reported in patients with cancer in general, regardless of type of AT administration. Patients with central venous catheters might be at increased risk of upper extremity VTE and this subset of patients may benefit from various risk reducing strategies. Caution is recommended while managing AT in this complex patient population, and more studies are needed to assess factors specifically associated with AT and bleeding after whipple procedure.