Abstract
Venous thromboembolism (VTE) is a well-recognized complication after gynecologic surgery. The risk that a surgical patient with a gynecologic malignancy will develop VTE after surgery is 40%, compared to 10–15% in a patient with no malignancy [ [1] Crandon A.J. Koutts J. Incidence of post-operative deep vein thrombosis in gynaecological oncology. Aust NZ J Obstet Gynaecol. 1983; 23: 216-219 Crossref PubMed Scopus (61) Google Scholar ]. VTE is highly preventable but not entirely avoidable. There are risk stratification models to help clinicians identify high-risk cases that may benefit from some form of prophylaxis. Such a model is the Caprini risk model, which stratifies VTE risk into 4 general categories based on the following scoring system: very low (score 0–1), low (score 2), moderate (score 3–4), and high (score ≥5) [ [2] Stroud W. Whitworth J.M. Miklic M. Schneider K.E. Finan M.A. Scalici J. et al. Validation of a venous thromboembolism risk assessment model in gynecologic oncology. Gynecol Oncol. 2014; 134: 160-163 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar ]. It is important to note that the majority of published data regarding VTE risk and prophylaxis include asymptomatic VTEs detected using imaging studies. The rate of symptomatic VTE, which carries clinical importance, is markedly lower. The risk of VTE, for example, is 40–80% in the high-risk group as defined by the Caprini model using imaging studies for diagnosis [ [2] Stroud W. Whitworth J.M. Miklic M. Schneider K.E. Finan M.A. Scalici J. et al. Validation of a venous thromboembolism risk assessment model in gynecologic oncology. Gynecol Oncol. 2014; 134: 160-163 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar ]; however, the baseline symptomatic VTE risk is only 6% in this same group [ [3] Gould M.K. Garcia D.A. Wren S.M. Karanicolas P.J. Arcelus J.I. Heit J.A. et al. Prevention of VTE in nonorthopedic surgical patients. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012; 141: e227S-e277S Crossref PubMed Scopus (1442) Google Scholar ]. We need to focus our efforts more on the prevention of symptomatic VTE, which can actually harm our patients.
Published Version
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