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200 Effectiveness of a thromboprophylaxis protocol in a high volume gynaecological oncological Canadian center
  1. Yasmine Ayari1,2,
  2. Elise De Castro Hillmann3,
  3. Laetitia Jourdan1 and
  4. Vanessa Samouëlian1,2,3
  1. 1Centre Hospitalier De L'université De Montréal (Chum), Montréal, Canada
  2. 2Université De Montréal, Montréal, Canada
  3. 3Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Canada


Introduction/Background The occurrence of thromboembolic events (TEE) in gynaecological oncological surgical populations reported in the literature is highly variable. This study evaluates efficacy of a single high volume gynaecological oncological surgical centre’s thromboprophylaxis protocol.

Methodology We conducted a retrospective cohort study of women undergoing gynaecological oncological surgeries at the Centre Hospitalier de l’Université de Montréal in 2015 (pre-ERAS implementation) and 2019–2022 (post-ERAS implementation). Exclusion criteria were same-day discharge and emergency surgeries. Our standardized thromboprophylactic protocol included systematic intermittent pneumatic compressions stockings (IPCS) installed pre-operatively until early mobilization and low molecular weight heparin (LMWH) initiated within 24 hours of surgery. We report demographic and clinical outcomes.

Results A total of 2420 patients were included. Surgical indications were ovarian (33%), endometrial/uterus (47%) and other (20%) cancers. Compliance to IPCS and LMWH were respectively 98,5% and 98,7%. Only 143 patients (5.9%) received prophylactic heparin at induction. TEE were reported in only 15/2420 patients (0.62%). Pulmonary embolism was diagnosed in twelve patients (0,5%) and deep venous phlebitis observed in three patients (0,1%). TEE occurred between first and 23rd post-operative days and ten occurred in the first week after surgery (66,6%). Only one of the 15 patients had laparoscopic surgery. Twelve patients had surgery for FIGO stage III and IV cancer or for recurrence. Patients who experienced a TEE had either ovarian cancer (n=7), endometrial/uterus cancer (n=5) or a recurrent gynaecological cancer (n=3). No TEE was observed among cervical, vaginal and vulvar cancers patients. None of the patients died from TEE.

Conclusion The occurrence of TEE in our gynaecological oncological population is more frequent in advanced or recurrent disease but the overall rate remains low (0,62%). Based on our data, the addition of heparin at induction could be re-evaluated, as IPCS and administration of LMWH postoperative day one appears to be a safe option, especially in laparoscopic cases.

Disclosures No conflict of interest.

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