卵巢癌大型手术后静脉血栓栓塞和出血的风险：标准住院期与延长的血栓预防时长。

Risk of venous thromboembolism and bleeding after major surgery for ovarian cancer: standard in-hospital versus extended duration of thromboprophylaxis.

机构信息

Amsterdam UMC - location University of Amsterdam, Vascular Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands.

Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, the Netherlands; Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

出版信息

J Thromb Haemost. 2023 Feb;21(2):294-302. doi: 10.1016/j.jtha.2022.11.017. Epub 2022 Dec 22.

DOI:10.1016/j.jtha.2022.11.017

PMID:36700503

Abstract

BACKGROUND

Venous thromboembolism (VTE) is a frequent complication in patients with ovarian cancer after major surgery. Based on limited data, international guidelines recommend extended thromboprophylaxis for up to 28 days.

OBJECTIVES

To assess the incidence of VTE and bleeding within 30 days following major surgery in patients with ovarian cancer and to evaluate the association between VTE and thromboprophylaxis duration.

METHODS

This was a single-center, retrospective, "before-after" cohort study in patients with ovarian cancer undergoing major surgery. Before July 2019, the local protocol mandated a standard course of thromboprophylaxis during hospital stay only. From July 2019 onward, patients received extended thromboprophylaxis for 28 days. The cumulative incidences of VTE and major bleeding within 30 days after surgery were estimated using the Kaplan-Meier method, with 95% confidence intervals (CIs). Cox regression analysis was performed to evaluate the association between thromboprophylaxis duration and VTE incidence.

RESULTS

Between January 2018 and December 2020, 250 women were included, of which 118 (47.2%) received extended and 132 (52.8%) standard thromboprophylaxis. During follow-up, 12 patients developed VTE (cumulative incidence, 4.8%; 95% CI, 2.1-7.4) and 2 major bleeding (cumulative incidence 0.8%; 95% CI, 0.0-1.9). Compared with standard thromboprophylaxis, VTE incidence was numerically lower with extended duration of thromboprophylaxis (5/118 [4.2%] vs 7/132 [5.3%]) but not significantly different (hazard ratio, 0.80; 95% CI, 0.25-2.52). The risk of major bleeding was similar in both groups (1/118 [0.8%] vs 1/132 [0.8%]; hazard ratio, 1.12; 95% CI, 0.07-17.89).

CONCLUSIONS

The cumulative VTE incidence in patients with ovarian cancer following major surgery was considerable. Extended thromboprophylaxis was safe and associated with a numerically lower risk of VTE but not significantly different.

摘要

背景

静脉血栓栓塞症（VTE）是卵巢癌患者在大手术后的常见并发症。基于有限的数据，国际指南建议对 VTE 进行长达 28 天的延长预防。

目的

评估卵巢癌患者在大手术后 30 天内 VTE 和出血的发生率，并评估 VTE 与预防时间之间的关系。

方法

这是一项单中心、回顾性、“前后”队列研究，纳入了接受大手术的卵巢癌患者。在 2019 年 7 月之前，当地方案规定仅在住院期间进行标准疗程的血栓预防。自 2019 年 7 月起，患者接受为期 28 天的延长预防。通过 Kaplan-Meier 方法估计术后 30 天内 VTE 和大出血的累积发生率，并提供 95%置信区间（CI）。采用 Cox 回归分析评估预防时间与 VTE 发生率之间的关系。

结果

在 2018 年 1 月至 2020 年 12 月期间，共纳入 250 名女性患者，其中 118 名（47.2%）接受了延长预防，132 名（52.8%）接受了标准预防。在随访期间，12 名患者发生 VTE（累积发生率 4.8%；95%CI，2.1-7.4），2 名患者发生大出血（累积发生率 0.8%；95%CI，0.0-1.9）。与标准预防相比，延长预防的 VTE 发生率略有降低（118 名患者中有 5 例[4.2%] vs. 132 名患者中有 7 例[5.3%]），但无显著差异（风险比，0.80；95%CI，0.25-2.52）。两组大出血的风险相似（118 名患者中有 1 例[0.8%] vs. 132 名患者中有 1 例[0.8%]；风险比，1.12；95%CI，0.07-17.89）。