Background Venous thromboembolism (VTE) is a serious and potentially fatal consequence of certain disease states and medical interventions, including hospitalisation and surgery. Surgical interventions are classified as high, moderate and low risk interventions. Although it is agreed that breast cancer operations represent a lower risk than abdominal and pelvic interventions, there is no consensus with regard to thromboprophylaxis.
Purpose The present non-interventional prospective cohort trial aimed to estimate the incidence of symptomatic VTE and to assess tolerability of available low molecular-weight heparins (LMWHs) in patients who received thromboprophylaxis after breast cancer and/or oncoplastic/reconstructive surgery. Primary outcome was the rate of VTE during the follow-up period of 3 months. Secondary outcomes were the evaluation of safety and tolerability of LMWHs postoperatively, the assessment of patient adherence and common practice with regard to administration, storage and disposal of LMWHs.
Materials and methods One hundred and forty consecutive patients who underwent surgery for breast cancer and received LMWH at the department of breast and sarcoma surgery of a single comprehensive cancer centre were assessed and followed up for a median of 137 days between 20 December, 2012 and 1 July, 2013. Every patient received the standard care. VTE risk factors as per the Caprini risk assessment model were identified for each patient preoperatively and were used to calculate a risk score. Tumour subtype and stage, type of surgery, clotting parameters, pre-existing VTE risk factors and the occurrence of bleeding complications were recorded. Patients also filled in a 14-item questionnaire.
Results No cases of VTE were recorded. Major bleeding complications were seen in 16.4% of the patients, while pain and bruising associated with the administration of the subcutaneous injections were experienced by 30.7% and 36.4%, respectively. No patients reported any missed doses of LMWH, but 20% reported multiple diversions from the official instructions for administration, and 22.9% disposed of the used syringes in the household waste.
Conclusions The safety of LMWHs in the prevention of VTE in this patient population is evident, although bleeding complications were recorded at a relatively high rate. The application of appropriate doses and treatment durations determined according to individual assessment of patients balanced against bleeding complications seem to be a very safe approach to prevent VTE in surgical breast cancer patients. Further investigation is needed.
No conflict of interest.
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