Abstract
ObjectiveGynaecological cancer surgery is associated with high rates of venous thromboembolism (VTE) despite recommended prophylaxis. We sought to investigate the impact of extended prophylaxis with fixed dose and weight based LMWH in patients undergoing gynaecological cancer surgery. MethodsVTE rates were recorded in patients who received LMWH prophylaxis (4500 IU Tinzaparin once daily) for the duration of hospital stay (2006–2012) (n = 610) and were compared with VTE rates in patients who underwent surgery after the introduction of extended prophylaxis (3500/4500 IU Tinzaparin for patients with BMI < 40kg/m2 and 75 IU/kg for BMI > 40 kg/m2) (2012–2017) (n = 651). Peak (4 h) anti-Xa levels in a subset of patients were also evaluated. Results73 (5.7%) cases of VTE were recorded during 1 year of follow-up. 20 cases occurred during hospital stay. There was no significant difference in the rate of VTE between the extended prophylaxis cohort and the standard prophylaxis cohort. 23/24 patients who developed VTE in the extended prophylaxis cohort received a fixed (4500 units) dose of Tinzaparin. 63% of patients who received a fixed LMWH dose had peak anti-Xa levels below the target range (0.2–0.4 IU/ml). Peak anti-Xa was lower in patients who subsequently developed VTE compared with those who received either fixed dose (P = 0.041) and weight adjusted Tinzaparin (P = 0.0006). ConclusionsExtended prophylaxis with Tinzaparin does not significantly reduce VTE rates in gynaecological cancer patients post surgery. Peak anti-Xa levels may be suboptimal in many patients receiving a fixed LMWH dose. Further studies are required to determine whether weight adjusted doses of Tinzaparin may provide more effective prophylaxis following gynaecological cancer surgery.
Highlights
Venous thromboembolism is a major cause of morbidity and mor tality in cancer patients
For gynaecological cancer patients, undergoing extended prophylaxis, the evidence is less clear, some studies have shown small reductions in venous thromboembolism (VTE) rates associated with extended prophylaxis [12], many observational studies suggest that extended prophylaxis is not warranted or effective in all patients [13,14,15]
A total of 1635 patients who underwent surgery for gynaecological cancer were assessed for eligibility for inclusion in the study. 252 pa tients were excluded from the study
Summary
Venous thromboembolism is a major cause of morbidity and mor tality in cancer patients. Patients are at risk during the postoperative period where VTE occurs in 6–7% of patients despite LMWH prophylaxis [3]. For gynaecological cancer patients, undergoing extended prophylaxis, the evidence is less clear, some studies have shown small reductions in VTE rates associated with extended prophylaxis [12], many observational studies suggest that extended prophylaxis is not warranted or effective in all patients [13,14,15]. Guidelines recommend fixed doses of LMWH for VTE prophylaxis post surgery without the need for anti-Xa monitoring or dose adjustment [22]. The aim of this study was to compare the incidence of VTE in a mixed population of gynaecological cancer patients who received extended LMWH (Tinzaparin) prophylaxis post surgery with a cohort of patients who received LMWH (Tinzaparin) prophylaxis during hospital stay only. A secondary aim was to evaluate peak anti-Xa levels in patients receiving a fixed dose of Tinzaparin compared with those receiving a weight adjusted dose
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