Abstract
Extended prophylaxis against venous thromboembolism (vte) after abdominal or pelvic cancer surgery with low molecular weight heparin (lmwh) is recommended by multiple guidelines. The primary objective of the present study was to assess adherence to that guideline recommendation at tertiary care centres within Hamilton Health Sciences (hhs). Given that an estimated 70% of the study population would be expected to receive extended prophylaxis, a sample size of 105 patients was calculated. Patients who had undergone abdominal or pelvic surgery for cancer from March 2012 to December 2015 were identified, and data were collected from electronic health records. The primary outcome was prescription of extended vte prophylaxis. Of 105 patients, only 3 received extended vte prophylaxis. Those 3 patients had serous carcinoma of the uterus, transitional cell carcinoma of the bladder, and cecal cancer. Of the 3 patients, 2 were followed by the thrombosis service while in hospital; none of the other 102 patients received any form of extended vte prophylaxis. Based on multiple randomized controlled trials, guidelines suggest lmwh prophylaxis for up to 4 weeks after major abdominal or pelvic cancer surgery. Despite those recommendations, postoperative extended vte prophylaxis is not commonly prescribed at hhs facilities. Next steps will include identification of barriers and an examination of how those barriers could be addressed. Failure to use prophylaxis is not consistent with evidence-based guidelines and is placing patients at risk of vte.
Highlights
Venous thromboembolism can have long-term adverse effects on patients[1], and in the case of pulmonary embolism, it can be fatal
Of the 3 patients, 2 were followed by the thrombosis service while in hospital; none of the other 102 patients received any form of extended vte prophylaxis
Patients who had undergone abdominal or pelvic surgery for cancer from March 2012 to December 2015 were identified from discharge records
Summary
Venous thromboembolism (vte) can have long-term adverse effects on patients[1], and in the case of pulmonary embolism, it can be fatal. Thrombosis is the 2nd leading cause of death in patients with cancer[2], and it places a heavy financial burden on the health care system[3]. Patients with malignancy are at higher risk for vte because of a hypercoagulable state[4]. The risk increases further after major surgery because of trauma and immobility. A prospective observational study by Agnelli et al.[5] found that vte was the leading cause of mortality 30 days postoperatively in patients undergoing cancer surgery. Most thrombotic events occurred 21 days after the initial procedure
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