Journal
GYNECOLOGIC ONCOLOGY
Volume 128, Issue 2, Pages 204-208Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.ygyno.2012.11.027
Keywords
Venous thromboembolism (VTE); Gynecologic cancer
Categories
Funding
- Cancer Center Support Grant (NCI) [P30 CA016672]
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Objective. To compare the incidence of venous thromboembolism (VTE) before and after the implementation of standardized extended duration prophylaxis guidelines in women undergoing laparotomy for gynecologic cancer. Methods. In October 2009, departmental practice guidelines were implemented for VTE prevention. Patients undergoing laparotomy for gynecologic cancer were started on low molecular weight heparin (LMWH) within 24 h of surgery and it was continued for a total of 28 days postoperatively. The incidence of VTE diagnosed within 30 and 90 days of surgery was determined and compared to a historic cohort of patients who underwent surgery prior to implementation of the guidelines. Results. The incidence of VIE within 30 days of surgery decreased from 2.7% (8/300) to 0.6% (2/334) following implementation of VTE prevention guidelines (78% reduction, p = 0.040). However, when the pre and post-guideline implementation groups were compared for the development of VIE within 90 days of surgery, there was no significant difference (11/300 (3.7%) vs. 10/334 (3.0%) respectively, p = 0.619). The median time between surgery and VTE diagnosis was 12 days in the pre-guideline implementation group, compared with 57 days in the post-guideline implementation group (p = 0.012). Conclusion. Patients receiving extended duration LMWH were found to have significantly lower rates of VIE within 30 days of surgery when compared with similar patients who did not receive extended duration LMWH. However, this effect was not sustained when the groups were compared for VIE diagnosis within 90 days of surgery. Additional study is needed to further reduce long-term VTE rates in this high-risk population. (C) 2012 Elsevier Inc. All rights reserved.
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