Incidence of symptomatic venous thrombosis in cervical and vulvo-vaginal carcinoma treated with concurrent chemoradiation, erythropoietin, and coumadin

Abstract

8101 Background: We had previously reported an increase in the incidence of symptomatic deep vein thrombosis (DVT) in 144 cervical and vulvo-vaginal cancer patients receiving recombinant human erythropoietin (rHuEpo) compared to patients not receiving rHuEpo in conjunction with chemoradiation therapy (Cancer 2003; 98: 1514-20). From April 2002, we instituted a policy of prophylactic low dose coumadin in an attempt to prevent DVT in this cohort receiving rHuEpo. Methods: A retrospective analysis of 56 consecutive patients with cervical or vulvo-vaginal carcinoma (FIGO Stage IB-IVA) who received chemoradiation and rHuEpo from 2001 to 2003 were performed. Subjects were divided into two groups: 32 subjects received rHuEpo alone, 24 subjects received daily coumadin (1–2 mg) in addition to rHuEpo. Primary endpoint was symptomatic DVT proven by duplex ultrasound. Results: There was no difference in baseline characteristics (e.g. age, stage, body mass index, mean and peak hemoglobin, WBC and platelet counts recorded at the time of peak hemoglobin, and number of transfusions) between these two cohorts (p ≥ 0.06, Wilcoxon rank sum test). 9 out of 24 patients (37.5%) had a symptomatic DVT while receiving coumadin compared to 10 out of 32 patients (31.3%) not on any anticoagulation. The incidence of thrombosis was not different between the two groups studied (p=0.62, Chi-square test; OR=1.32, 95% CI=(0.43,4.02)). Out of the 9 patients who had a DVT while receiving coumadin, 7 developed upper extremity (UE) DVT while 3 had lower extremity (LE) DVT (1 patient had both UE and LE thromboses). For the 10 patients who were not on coumadin and developed thromboses, 9 were UE DVT and 2 were LE DVT (1 patient had both UE and LE DVT). There was no difference between the two groups in the percentage of patients with UE DVT (p=0.83, Chi-square test; OR=1.14, 95% CI=(0.35,3.74)) or LE DVT (p=0.64, Fisher's test; OR=2.2, 95% CI=(0.33,14.79)). Conclusions: Daily low dose coumadin did not alter the incidence of symptomatic DVT in patients with cervical or vulvo-vaginal cancer who received rHuEpo in conjunction with chemoradiation therapy. No significant financial relationships to disclose.