Risk Factor of Deep Vein Thrombosis in Gynecologic Cancer Patients at Rajavithi Hospital

Nawapas Pookcharoen,Putsarat Insin,Suvanna Asavapiriyanon

doi:10.31557/apjcc.2018.3.1.5

Nawapas Pookcharoen, Putsarat Insin + Show 1 more

Open Access

https://doi.org/10.31557/apjcc.2018.3.1.5

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Abstract

Background: Venous thromboembolism (VTE), that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant complication after major pelvic surgery and potentially lethal disease in gynecologic cancer patients. However, its incidence and associated risk factors have not been well established.Objectives: To evaluate risk factors that may be associated with deep vein thrombosis (DVT) in gynecologic cancer patients.Materials and Methods: This retrospective case-control study included patients who diagnosed as gynecologic cancer with or without DVT between January 2002 and December 2016 at Rajavithi Hospital. The presence of DVT was confirmed by either color doppler ultrasonography or computed tomography scan. Patient's demographic data, type and stage of cancer, including treatment modalities were compared. Univariate analysis and multivariate logistic regression analysis were analyzed to calculate odds ratios (OR) and determine independent risk factors for DVT.Results: Over 14 years periods, 242 patients with DVT were identified in a total 8476 gynecologic cancer patients. The incidence of DVT was 2.85% in this patient setting. Complete data were available in 468 patients, 156 (33.3%) cases with DVT diagnosed were compared with 312 (66.7%) controls without DVT. Among patients with DVT, the median time to DVT diagnosis was 4 months (IQR 2-12 months) after diagnosis of cancer, most of cases (89.5%) were symptomatic DVT, and a half of them (49%) were detected in ovarian cancer. In a multivariate analysis, 3 significant predictors of developing DVT were identified: advanced-stage cancer (OR 7.22; 95%CI 4.62-11.28, p<0.001), patient undergoing lymphadenectomy (OR 1.90; 95%CI 1.21-2.98, p=0.005), and patient with massive operative blood loss (≥1500 ml; OR 2.09; 95%CI 1.12-3.91, p=0.021).Conclusions: Awareness of DVT is the best way to prevent the venous thromboembolism. Therefore, an appropriate prophylaxis and closed monitoring of gynecologic cancer patients with advanced-stage cancer, undergoing lymphadenectomy, and massive operative blood loss should be mandatory to against thromboembolism complications.

Highlights

Venous thromboembolism (VTE), presenting as deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality
The medical records of the patients diagnosed with gynecologic cancer with or without DVT between 1st January 2002 and 31st December 2016 were reviewed
DVT was defined by the following inclusion criteria: 1) radiological evidence confirmation of DVT by either using compression ultrasonography with Doppler imaging for suspected extremities DVT or computed tomography scan (CT)/ magnetic resonance imaging (MRI) for suspected deep pelvic or abdominal veins thrombosis and 2) absence of signs and symptoms consistent with DVT in the admission history and physical examination

Summary

Introduction

Venous thromboembolism (VTE), presenting as deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality. This retrospective case-control study was designed to evaluate the incidence of DVT and explore the risk factor associated with DVT in the gynecologic cancer patients at Rajavithi Hospital, a tertiary referral center in Thailand. The controls were selected from a patient database based upon eligible criteria, and matched with the cases on the type of cancer (including ovarian cancer, uterine cancer, cervical cancer, and vulvar cancer) at time of DVT diagnosis.

Results

Conclusion