Update on extended prophylaxis for venous thromboembolism following surgery for gynaecological cancers

Abstract

Gynaecological cancers are associated with high rates of VTE varying from 6% in endometrial cancer to up to 43% in clear cell cancer of the ovary. The risk of VTE is particularly high following gynaecological cancer surgery where VTE occurs in 6–7% of patients despite LMWH prophylaxis. The presence of a gynaecological malignancy increases the rate of post-operative VTE fourfold compared with patients with benign disease. The risk of VTE persists beyond hospital stay hence guidelines recommend extended prophylaxis (28 days) with LMWH for patients undergoing pelvic abdominal surgery for cancer. Gynaecological cancer surgery has evolved with increasing use of Minimally Invasive Surgery (MIS) and improvements in post-operative care with associated shorter hospital stay. The aim of this review is to evaluate on the risk of venous thromboembolism following gynaecological cancer surgery and the role of extended thromboprophylaxis in the era of MIS. The risk of VTE following MIS for cancer is low and more data is required to justify the use of extended prophylaxis. VTE risk varies depending on tumour, patient, and treatment factors. Individual risk assessment is required to optimise prophylaxis in these patients. Barriers to the use of extended prophylaxis include concerns regarding bleeding risk and physician perception that the risk of VTE is low particularly following laparoscopy. The introduction of new oral anticoagulants may play a role in post-operative prophylaxis in the future however data is lacking in gynaecological cancer patients.