Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse.
School of Medicine, State University of New York Upstate Medical University, Syracuse.
JAMA Otolaryngol Head Neck Surg. 2021 Apr 1;147(4):320-328. doi: 10.1001/jamaoto.2020.5151.
Venous thromboembolism (VTE) is associated with substantial morbidity and is the most common factor associated with preventable death among hospitalized patients. Data from otolaryngologic studies suggest that the risk of VTE may be underestimated among high-risk patients, particularly among those undergoing oncologic procedures. The incorporation of prolonged-duration chemoprophylaxis (PDC) into preventive therapy has been associated with substantial decreases in VTE incidence among patients undergoing oncologic surgery. However, bleeding remains a major concern among otolaryngologists, and substantial variation exists in the use of thromboprophylaxis.
To assess the association between PDC and VTE in high-risk patients with head and neck cancer undergoing oncologic procedures.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study identified 750 patients with biopsy-confirmed head and neck cancer and a Caprini risk score of 8 or higher who underwent inpatient oncologic surgery at a tertiary care referral center between January 1, 2014, and February 1, 2020. After exclusions, 247 patients were included in the study; patients were divided into 2 cohorts, traditional and PDC, based on the duration of prophylaxis. Univariate and multivariate analyses were performed to examine the development of VTE and bleeding-associated complications during the 30-day postoperative period. Data were analyzed from April 1 to April 30, 2020.
PDC, defined as 7 or more postoperative days of chemoprophylaxis.
VTE and bleeding events during the 30-day postoperative period.
Among 247 patients (mean [SD] age, 63.1 [11.1] years; 180 men [72.9%]) included in the study, 106 patients (42.9%) received traditional prophylaxis, and 141 patients (57.1%) received PDC. The incidence of VTE was 5 of 106 patients (4.7%) in the traditional cohort and 1 of 141 patients (0.7%) in the PDC cohort (odds ratio [OR], 0.15; 95% CI, 0.003-1.33). In the multivariate logistic regression analysis, PDC was independently associated with reductions in the risk of VTE (OR, 0.04; 95% CI, 0.001-0.46). The incidence of bleeding events was 1 of 106 patients (0.9%) in the traditional cohort and 6 of 141 patients (4.3%) in the PDC cohort (OR, 4.64; 95% CI, 0.55-217.00).
The use of chemoprophylaxis for high-risk patients with head and neck cancer remains a high-priority topic. The results of this study suggest that PDC may be associated with reductions in VTE among this patient population. However, the associated increase in nonfatal bleeding events warrants careful consideration and further highlights the need to determine an optimal duration for chemoprophylaxis among this distinct cohort.
重要性：静脉血栓栓塞症（VTE）与大量发病率相关，是住院患者中最常见的可预防死亡因素。耳鼻喉科研究数据表明，高危患者的 VTE 风险可能被低估，尤其是那些接受肿瘤治疗的患者。将延长疗程化学预防（PDC）纳入预防性治疗与肿瘤手术后 VTE 发生率的显著降低有关。然而，出血仍然是耳鼻喉科医生的主要关注点，血栓预防的使用存在很大差异。
目的：评估在接受肿瘤治疗的头颈部癌症高危患者中，PDC 与 VTE 之间的关联。
设计、地点和参与者：这项回顾性队列研究纳入了 750 名活检确诊的头颈部癌症且 Caprini 风险评分≥8 分的患者，这些患者在一家三级转诊中心接受了住院肿瘤手术，研究时间为 2014 年 1 月 1 日至 2020 年 2 月 1 日。排除后，共有 247 名患者纳入研究；根据预防时间的长短，患者被分为传统组和 PDC 组。进行了单变量和多变量分析，以检测术后 30 天内 VTE 和出血相关并发症的发生情况。数据分析于 2020 年 4 月 1 日至 4 月 30 日进行。
暴露：PDC，定义为术后 7 天或以上的化学预防。
主要结果和测量：术后 30 天内 VTE 和出血事件。
结果：在纳入的 247 名患者（平均[标准差]年龄 63.1[11.1]岁；180 名男性[72.9%]）中，106 名患者（42.9%）接受了传统预防，141 名患者（57.1%）接受了 PDC。传统组 5 例（4.7%）患者发生 VTE，PDC 组 1 例（0.7%）患者发生 VTE（比值比[OR]，0.15；95%置信区间，0.003-1.33）。在多变量逻辑回归分析中，PDC 与 VTE 风险降低独立相关（OR，0.04；95%置信区间，0.001-0.46）。传统组发生出血事件 1 例（0.9%），PDC 组发生出血事件 6 例（4.3%）（OR，4.64；95%置信区间，0.55-217.00）。
结论和相关性：高危头颈部癌症患者的化学预防仍然是一个高度优先的话题。这项研究的结果表明，PDC 可能与该患者群体的 VTE 减少有关。然而，相关的非致命性出血事件增加需要仔细考虑，并进一步强调需要确定该特定队列中化学预防的最佳持续时间。
