Article Text
Abstract
Introduction Venous thromboembolism(VTE) is a frequent cause of morbidity and mortality in cancer patients. Although gynecologic cancer, anemia and chemotherapy increase VTE rates, there is limited data on thromboprophylaxis during chemotherapy in gynecology oncology. The aim of this study was to evaluate the prevalence of VTE during chemotherapy in gynecologic oncology, assess patient characteristics and inform practice recommendations.
Methods This prospective cohort study included consecutive gynecologic oncology patients treated with chemotherapy at two academic centers between January 2022-March 2024. Deep venous thrombosis(DVT) or pulmonary embolism(PE) were diagnosed using leg doppler ultrasound or computed tomographic(CT) pulmonary angiography, respectively.
Results Of 226 patients, 17(8%) were diagnosed with a VTE over a median follow-up of 5.2months, including 13 DVT(6%) and 6 PE(3%). Ten(59%) patients were diagnosed during chemotherapy, 5(29%) prior to chemotherapy and 2(12%) after chemotherapy. Ten(59%) underwent first-line chemotherapy and 7(41%) underwent chemotherapy for recurrence. Eleven(65%) received carboplatin/cisplatin-paclitaxel, 3(18%) carboplatin, 1(6%) cisplatin-paclitaxel-bevacizumab, 1(6%) paclitaxel-bevacizumab, and 1(6%) doxorubicin. Nine(53%) had ovarian, 5(29%) endometrial and 3(18%) cervical cancer; 12(71%) were stage III/IV and all had high grade histology. Thirteen(76%) patients had pre-chemotherapy anemia; one received blood transfusions, but no intravenous iron. Proportion of mild(110-119g/L) and moderate(90-109g/L) anemia was 62% and 38%. Nine(53%) had pre-chemotherapy platelets ≥350x109/L. Seven(41%) had hypertension, 4(24%) prior VTE and 1(6%) BMI≥35kg/m2. Eleven(65%) patients with VTE had a Khorana score >2 and would have required thromboprophylaxis during chemotherapy.
Conclusion/Implications Thromboprophylaxis during chemotherapy may be considered in gynecology oncology patients due to high VTE rates, similarly to other cancer types for which primary prophylaxis is recommended.