abstract
OBJECTIVE:
Extended-duration
thromboprophylaxis for 4 weeks after discharge has been demonstrated to
reduce venous thromboembolic events (VTE) in
cancer
patients undergoing abdominopelvic surgery and is recommended in
national guidelines. We examined the utilization and effectiveness of
extended-duration low molecular weight heparin prophylaxis in high-risk
cancer patients.
METHODS:
We analyzed patients with colon,
ovarian, and uterine
cancer
who underwent surgery from 2009 to 2013 and who were recorded in the
MarketScan database. Multivariable models and propensity score analysis
with inverse probability of treatment weight were developed to examine
uptake and predictors of use of post-discharge low molecular weight
heparin (LMWH), as well as associated adverse events (transfusion, and
hemorrhage).
RESULTS:
A
total of
63,280 patients were identified. Use of extended-duration
prophylaxis increased from 2009 to 2013 from 1.4% to 1.7% (P=0.67) for
colectomy, 5.9% to
18.3% for ovarian cancer surgery (P<0.001), and 6.3% to 12.2% (P<0.001) for hysterectomy for endometrial
cancer.
There was no association between use of extended-duration prophylaxis
and reductions in VTE for any of the procedures: colectomy (2.4% with
extended-duration prophylaxis vs. 2.9% without prophylaxis, OR=0.84; 95%
CI, 0.54-1.31),
ovarian cancer-directed
surgery (3.7% vs. 3.6%, OR=1.01; 95% CI, 0.76-1.33), hysterectomy (2.1%
vs. 2.1%; OR=0.96; 95% CI, 0.67-1.38). Extended-duration prophylaxis
was associated with an increased risk of adverse postoperative events:
2.20 (95% CI, 1.51-3.19) after colectomy, 1.24 (95% CI, 0.92-1.68)
following
ovarian cancer-directed surgery and 0.99 (95% CI, 0.66-1.48) for hysterectomy for endometrial
cancer.
CONCLUSION:
Use of extended-duration thromboprophylaxis is low among high-risk
cancer patients undergoing surgery.
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