Evaluation of Prophylaxis and Management of Venous Thromboembolism in Surgical Cancer Patients

Abstract

Background: Deep venous thrombosis is considered to be one other challenges in medical practice because of silent nature in most of the cases and the complications that may end with death. It's very difficult to study its incidence. There is strong relation between malignancy and thrombosis. The incidence of deep venous thrombosis in malignancy differs according to the type of the tumor. There are many risk factors of deep venous thrombosis other than malignancy like surgery, history of previous attack, immobility, obesity, pregnancy, and contraceptives, and others. The incidence differs from one risk factor to another and also according to presence of other co-morbidities. Venous thrombosis occurs as a result of one or more three factors postulated by Virchow either abnormalities of blood flow, abnormalities of blood or vascular injury. Deep venous thrombosis in malignancy may be due to other causes like surgery, chemotherapy or central venous catheters. Objective: The aim of this work was to evaluate the efficacy of prophylactic measures before, during and after surgery in reducing the risk of developing venous thromboembolism in cancer patients undergoing surgery and how to mange the thromboembolic events if occurred after surgery in surgical cancer patients. Patients and Methods: This is a prospective study conducted on 20 patients presented to the Oncology surgery unit and Vascular surgery outpatient clinic of AL-Hussein University Hospital and Ahmed Maher Teaching Hospital between December, 2017 and June, 2018. Patients with operable tumors were included in this study while cancer patients with comorbidities interfering with surgical procedures were excluded. Data were recorded in predesigned sheet including age, sex, special habits, obesity, history of previous DVT and history of chronic illness. Duplex study was done pre and post operative to diagnose DVT .Time of operations were assessed. All included patients were assessed for the appropriate regimen of prophylaxis either mechanical or pharmacological or combination of both. Diagnosed patients with DVT after surgery were treated with heparin and oral anticoagulants. Results: Of the 20 patients, 9 (45%) were females and 11(55%) were males. The age of the patients ranged between 33 and 82 years with a mean age at presentation was 59.85 years. With the 20 patients who used preoperative prophylaxis regimens, the incidence of postoperative deep vein thrombosis was 10%; with average time of DVT development of (1.25 ± 0.35) months. In addition, the rate of bleeding was 5%; developed at 1-month duration. Conclusion: patients with cancer particularly those undergoing surgery are at risk of developing venous thromboembolic complications. Low molecular weight heparin (LMWH) and Unfractionated heparin (UFH) prophylaxis in patients undergoing cancer related surgery has proved to be effective and safe in reducing the risk of an acute event. Thromboprophylaxis with LMWH, UFH and mechanical methods should be considered for all patients with a malignancy who undergo surgery. Recommendation: Both pharmacological and mechanical thromoboprophylaxis measures are required to minimize the risk of developing deep vein thrombosis and its complications in surgical cancer patients (SCP).