Beyond prophylaxis

Extended risk of venous thromboembolism following primary debulking surgery for ovarian cancer

Beth E. Wagner, Carrie L. Langstraat, Michaela E. McGree, Amy L. Weaver, Shikha Sarangi, Bahareh Mokri, Sean Christopher Dowdy, William Arthur Cliby, Amanika Kumar, Jamie N Bakkum-Gamez

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To determine the incidence and risk factors for venous thromboembolism (VTE) within six months after primary debulking surgery (PDS) for epithelial ovarian cancer (EOC). Methods: In a historical cohort, we estimated the cumulative incidence of clinically diagnosed VTE within 6 months among consecutive women who underwent PDS for EOC at a single institution from 1/1/2003 to 12/31/2011. We evaluated perioperative variables as potential risk factors of VTE within 6 months during the postoperative period using univariate and multivariable Cox proportional hazards models. Results: Among 860 women without an immediate history (past 30 days) of a VTE, the cumulative incidence of VTE was 7.5% (95% CI, 5.7–9.3) by 30 days and 13.8% (95% CI, 11.4–16.2) by 6 months following surgery. Macroscopic residual disease (adjusted HR 1.99 [95% CI 1.35–2.94] vs microscopic), increasing estimated blood loss (1.25 [1.05–1.49] per doubling), longer hospital length of stay (3.00 [1.57–5.75]), and experiencing a cardiac event within 30 postoperative days (2.72 [1.55–4.80]) were independently associated with subsequent VTE within 6 months. In-hospital VTE prophylaxis included heterogeneous approaches; dual prophylaxis did not impact 30-day or 6-month VTE rates. Conclusions: VTE occurred in 1 in 7 women with EOC within 6 months of PDS—a substantial risk of VTE that extends into the adjuvant chemotherapy period. Novel prophylactic measures should be explored in these women at high risk for VTE.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Venous Thromboembolism
Ovarian Neoplasms
Length of Stay
Incidence
Adjuvant Chemotherapy
Proportional Hazards Models
Postoperative Period
History

Keywords

  • Ovarian cancer
  • Venous thromboembolism

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Beyond prophylaxis : Extended risk of venous thromboembolism following primary debulking surgery for ovarian cancer. / Wagner, Beth E.; Langstraat, Carrie L.; McGree, Michaela E.; Weaver, Amy L.; Sarangi, Shikha; Mokri, Bahareh; Dowdy, Sean Christopher; Cliby, William Arthur; Kumar, Amanika; Bakkum-Gamez, Jamie N.

In: Gynecologic Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Wagner, Beth E. ; Langstraat, Carrie L. ; McGree, Michaela E. ; Weaver, Amy L. ; Sarangi, Shikha ; Mokri, Bahareh ; Dowdy, Sean Christopher ; Cliby, William Arthur ; Kumar, Amanika ; Bakkum-Gamez, Jamie N. / Beyond prophylaxis : Extended risk of venous thromboembolism following primary debulking surgery for ovarian cancer. In: Gynecologic Oncology. 2018.
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abstract = "Objective: To determine the incidence and risk factors for venous thromboembolism (VTE) within six months after primary debulking surgery (PDS) for epithelial ovarian cancer (EOC). Methods: In a historical cohort, we estimated the cumulative incidence of clinically diagnosed VTE within 6 months among consecutive women who underwent PDS for EOC at a single institution from 1/1/2003 to 12/31/2011. We evaluated perioperative variables as potential risk factors of VTE within 6 months during the postoperative period using univariate and multivariable Cox proportional hazards models. Results: Among 860 women without an immediate history (past 30 days) of a VTE, the cumulative incidence of VTE was 7.5{\%} (95{\%} CI, 5.7–9.3) by 30 days and 13.8{\%} (95{\%} CI, 11.4–16.2) by 6 months following surgery. Macroscopic residual disease (adjusted HR 1.99 [95{\%} CI 1.35–2.94] vs microscopic), increasing estimated blood loss (1.25 [1.05–1.49] per doubling), longer hospital length of stay (3.00 [1.57–5.75]), and experiencing a cardiac event within 30 postoperative days (2.72 [1.55–4.80]) were independently associated with subsequent VTE within 6 months. In-hospital VTE prophylaxis included heterogeneous approaches; dual prophylaxis did not impact 30-day or 6-month VTE rates. Conclusions: VTE occurred in 1 in 7 women with EOC within 6 months of PDS—a substantial risk of VTE that extends into the adjuvant chemotherapy period. Novel prophylactic measures should be explored in these women at high risk for VTE.",
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T2 - Extended risk of venous thromboembolism following primary debulking surgery for ovarian cancer

AU - Wagner, Beth E.

AU - Langstraat, Carrie L.

AU - McGree, Michaela E.

AU - Weaver, Amy L.

AU - Sarangi, Shikha

AU - Mokri, Bahareh

AU - Dowdy, Sean Christopher

AU - Cliby, William Arthur

AU - Kumar, Amanika

AU - Bakkum-Gamez, Jamie N

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To determine the incidence and risk factors for venous thromboembolism (VTE) within six months after primary debulking surgery (PDS) for epithelial ovarian cancer (EOC). Methods: In a historical cohort, we estimated the cumulative incidence of clinically diagnosed VTE within 6 months among consecutive women who underwent PDS for EOC at a single institution from 1/1/2003 to 12/31/2011. We evaluated perioperative variables as potential risk factors of VTE within 6 months during the postoperative period using univariate and multivariable Cox proportional hazards models. Results: Among 860 women without an immediate history (past 30 days) of a VTE, the cumulative incidence of VTE was 7.5% (95% CI, 5.7–9.3) by 30 days and 13.8% (95% CI, 11.4–16.2) by 6 months following surgery. Macroscopic residual disease (adjusted HR 1.99 [95% CI 1.35–2.94] vs microscopic), increasing estimated blood loss (1.25 [1.05–1.49] per doubling), longer hospital length of stay (3.00 [1.57–5.75]), and experiencing a cardiac event within 30 postoperative days (2.72 [1.55–4.80]) were independently associated with subsequent VTE within 6 months. In-hospital VTE prophylaxis included heterogeneous approaches; dual prophylaxis did not impact 30-day or 6-month VTE rates. Conclusions: VTE occurred in 1 in 7 women with EOC within 6 months of PDS—a substantial risk of VTE that extends into the adjuvant chemotherapy period. Novel prophylactic measures should be explored in these women at high risk for VTE.

AB - Objective: To determine the incidence and risk factors for venous thromboembolism (VTE) within six months after primary debulking surgery (PDS) for epithelial ovarian cancer (EOC). Methods: In a historical cohort, we estimated the cumulative incidence of clinically diagnosed VTE within 6 months among consecutive women who underwent PDS for EOC at a single institution from 1/1/2003 to 12/31/2011. We evaluated perioperative variables as potential risk factors of VTE within 6 months during the postoperative period using univariate and multivariable Cox proportional hazards models. Results: Among 860 women without an immediate history (past 30 days) of a VTE, the cumulative incidence of VTE was 7.5% (95% CI, 5.7–9.3) by 30 days and 13.8% (95% CI, 11.4–16.2) by 6 months following surgery. Macroscopic residual disease (adjusted HR 1.99 [95% CI 1.35–2.94] vs microscopic), increasing estimated blood loss (1.25 [1.05–1.49] per doubling), longer hospital length of stay (3.00 [1.57–5.75]), and experiencing a cardiac event within 30 postoperative days (2.72 [1.55–4.80]) were independently associated with subsequent VTE within 6 months. In-hospital VTE prophylaxis included heterogeneous approaches; dual prophylaxis did not impact 30-day or 6-month VTE rates. Conclusions: VTE occurred in 1 in 7 women with EOC within 6 months of PDS—a substantial risk of VTE that extends into the adjuvant chemotherapy period. Novel prophylactic measures should be explored in these women at high risk for VTE.

KW - Ovarian cancer

KW - Venous thromboembolism

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DO - 10.1016/j.ygyno.2018.11.021

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JF - Gynecologic Oncology

SN - 0090-8258

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