Is forgoing chemical venous thromboembolism prophylaxis for women undergoing breast-conserving surgery for breast cancer safe?

Samer G. Zammar, Barbara A Pockaj, Chee Chee Stucky, Nabil Wasif, Richard J. Gray

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Cancer patients have a 4 to 7 fold increased risk of venous thromboembolism (VTE) vs the normal population. Chest guidelines recommend no chemical VTE prophylaxis for women with a <1.5% risk for VTE. Although the risk of VTE among women undergoing breast-conserving therapy is reported to be low overall, the rate without chemical prophylaxis has not been defined. The objective of the study was to establish the VTE risk among women undergoing breast-conserving surgery (BCS) who did not receive chemical VTE prophylaxis. Methods From a prospective breast cancer database, 1,000 consecutive patients who underwent BCS without chemical VTE prophylaxis and with mechanical prophylaxis (support hose and intermittent pneumatic compression devices) were analyzed for VTE occurrence within 30 days postoperatively. Institutional review board approval was obtained. Results The mean age was 65.4 ± 11.7 years, and mean body mass index was 27.3 ± 5.7. About 81.9% of the patients were postmenopausal. Median tumor size was 1.1 cm, and 24.7% of patients had lymph node metastases. The 30-day rate of clinically significant VTE was 0% (95% CI 0% to.37%). Hematomas requiring surgical intervention occurred among.6% of patients. Conclusions This cohort demonstrates that breast cancer patients undergoing BCS may be safely managed without chemical VTE prophylaxis because the risk with only mechanical prophylaxis is acceptable.

Original languageEnglish (US)
Pages (from-to)1162-1166
Number of pages5
JournalAmerican Journal of Surgery
Volume212
Issue number6
DOIs
StatePublished - Dec 1 2016

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Segmental Mastectomy
Venous Thromboembolism
Breast Neoplasms
Intermittent Pneumatic Compression Devices
Research Ethics Committees
Hematoma
Neoplasms
Breast
Body Mass Index
Thorax
Lymph Nodes
Databases
Guidelines
Neoplasm Metastasis

Keywords

  • Breast
  • Cancer
  • Lumpectomy
  • Prophylaxis
  • Thromboembolism
  • VTE

ASJC Scopus subject areas

  • Surgery

Cite this

Is forgoing chemical venous thromboembolism prophylaxis for women undergoing breast-conserving surgery for breast cancer safe? / Zammar, Samer G.; Pockaj, Barbara A; Stucky, Chee Chee; Wasif, Nabil; Gray, Richard J.

In: American Journal of Surgery, Vol. 212, No. 6, 01.12.2016, p. 1162-1166.

Research output: Contribution to journalArticle

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abstract = "Background Cancer patients have a 4 to 7 fold increased risk of venous thromboembolism (VTE) vs the normal population. Chest guidelines recommend no chemical VTE prophylaxis for women with a <1.5{\%} risk for VTE. Although the risk of VTE among women undergoing breast-conserving therapy is reported to be low overall, the rate without chemical prophylaxis has not been defined. The objective of the study was to establish the VTE risk among women undergoing breast-conserving surgery (BCS) who did not receive chemical VTE prophylaxis. Methods From a prospective breast cancer database, 1,000 consecutive patients who underwent BCS without chemical VTE prophylaxis and with mechanical prophylaxis (support hose and intermittent pneumatic compression devices) were analyzed for VTE occurrence within 30 days postoperatively. Institutional review board approval was obtained. Results The mean age was 65.4 ± 11.7 years, and mean body mass index was 27.3 ± 5.7. About 81.9{\%} of the patients were postmenopausal. Median tumor size was 1.1 cm, and 24.7{\%} of patients had lymph node metastases. The 30-day rate of clinically significant VTE was 0{\%} (95{\%} CI 0{\%} to.37{\%}). Hematomas requiring surgical intervention occurred among.6{\%} of patients. Conclusions This cohort demonstrates that breast cancer patients undergoing BCS may be safely managed without chemical VTE prophylaxis because the risk with only mechanical prophylaxis is acceptable.",
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N2 - Background Cancer patients have a 4 to 7 fold increased risk of venous thromboembolism (VTE) vs the normal population. Chest guidelines recommend no chemical VTE prophylaxis for women with a <1.5% risk for VTE. Although the risk of VTE among women undergoing breast-conserving therapy is reported to be low overall, the rate without chemical prophylaxis has not been defined. The objective of the study was to establish the VTE risk among women undergoing breast-conserving surgery (BCS) who did not receive chemical VTE prophylaxis. Methods From a prospective breast cancer database, 1,000 consecutive patients who underwent BCS without chemical VTE prophylaxis and with mechanical prophylaxis (support hose and intermittent pneumatic compression devices) were analyzed for VTE occurrence within 30 days postoperatively. Institutional review board approval was obtained. Results The mean age was 65.4 ± 11.7 years, and mean body mass index was 27.3 ± 5.7. About 81.9% of the patients were postmenopausal. Median tumor size was 1.1 cm, and 24.7% of patients had lymph node metastases. The 30-day rate of clinically significant VTE was 0% (95% CI 0% to.37%). Hematomas requiring surgical intervention occurred among.6% of patients. Conclusions This cohort demonstrates that breast cancer patients undergoing BCS may be safely managed without chemical VTE prophylaxis because the risk with only mechanical prophylaxis is acceptable.

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