| dc.description.abstract | Background:
Gynaecological malignancy and surgery are independently associated with the
highest risks of VTE. However, factors influencing the rate of recurrent VTE in patients
with gynaecological malignancy are unknown. Moreover, while the extended LMWH
prophylaxis significantly reduces the incidence of postoperative VTE, patients
experience and compliance with the postoperative prophylaxis have not been
examined before.
Objectives:
Primary objectives included: the assessment of incidence/risk factors for recurrent
VTE, VTE effect on overall/progression-free survival in patients with gynaecological
cancer; secondary: the role of laboratory (WCC, Hb, PLT, Urea, Creatinine, Albumin)
and plasma coagulation factors (fibrinogen, D-Dimer, factor V, VIII, free Protein S, and
Calibrated Automated Thrombogram assay) as predictive biomarkers of VTE
recurrence, patients experience/compliance with extended thromboprophylaxis.
Patients and methods:
This was a retrospective study conducted in a tertiary Gynaecological Cancer Centre
between 2006-2017. Patients with VTE related to gynecological cancer were
identified. Demographics, histology, stage, surgery, chemotherapy, co-morbidities,
and timing of VTE were recorded. Biomarkers were examined from plasma obtained
before surgery. In addition, consecutive patients who received LMWH prophylaxis for
four weeks following surgery, between 07/2017-03/2018, were recruited for a
prospective study examining patients experience and compliance with extended
thromboprophylaxis. Participants received a logbook to record injections/side effects.
Results:
The incidence of recurrent VTE was 22%. The risk was highest if the first VTE occurred
before the primary cancer treatment. The highest number of VTE recurrences
occurred within a year of the primary VTE event (67% within six months, 81% within
12 months). Most (63%) were on a therapeutic dose of LMWH at the time of their
recurrent VTE. There was no difference in progression-free and overall survival
between patients with a single and recurrent VTE. There were no differences between
the two groups in age, BMI, presence/absence of a second malignancy, smoking,
menopausal status, type of surgery, or Charlson Comorbidity Index. Patients with
recurrent VTE had significantly higher monocyte count vs the non-recurrent VTE
group. Fibrinogen, D-Dimer, Factor V, Factor VIIIc, protein S levels, and thrombin
generation did not significantly differ. Most (62%) patients were compliant with a 28-
day course of LMWH. Over half was able to self-administer the injections. Although
satisfaction was high (78%), most (86%) admitted they would prefer an oral medication
if available. The majority (84%) reported at least one side effect (bruising/pain were
the most frequent).
Conclusion:
In conclusion, patients who experienced their first VTE before any form of cancer
treatment were more likely to experience recurrent VTE. Moreover, the risk remained
high despite standard anticoagulation treatment. This study did not identify biomarkers
predictive of risk of recurrent VTE; however, the sample size was small. Patients
compliance with extended LMWH prophylaxis was good and satisfaction was high. | en |
