Prospective Study of Venous Thromboembolism in Patients With Head and Neck Cancer After Surgery

Study Questions:

What is the incidence of venous thromboembolism (VTE) in postoperative patients with head and neck cancer?

Methods:

This was a prospective study of 100 consecutive patients hospitalized at a tertiary care academic surgical center who underwent surgery to treat head and neck cancer. Routine chemoprophylaxis was not used. On postoperative day (POD) 2 or 3, participants received clinical examination and duplex ultrasonographic evaluation (US). Participants with negative findings on clinical examination and US were followed up clinically; participants with evidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were given therapeutic anticoagulation. Participants with superficial VTE underwent repeated US on POD 4, 5, or 6. Participants were monitored for 30 days after surgery. The main outcome measure was the total number of new cases of VTE (superficial and deep) identified within 30 days of surgery and confirmed on diagnostic imaging.

Results:

Of the 111 participants enrolled, 11 withdrew before completing the study; thus, 100 participants were included. The overall incidence of VTE was 13%. Eight participants were identified with clinically significant VTE: seven DVT and one PE. An additional five participants had asymptomatic lower extremity superficial VTE detected on US alone. Fourteen percent of patients received some form of postoperative anticoagulation therapy; the rate of bleeding complications in these patients (30.1%) was higher than that in patients without anticoagulation therapy (5.6%) (p = 0.01).

Conclusions:

The authors concluded that hospitalized patients with head and neck cancer not routinely receiving anticoagulation therapy after surgery have an increased risk of VTE.

Perspective:

This study reported a 13% overall incidence of VTE in high-risk head and neck cancer surgery patients who did not routinely undergo anticoagulation therapy after surgery. Although the present study was not designed to assess the risk of anticoagulation, the investigators noted a significantly higher rate of bleeding complications in the participants who received anticoagulation. Overall, these results support the use of routine VTE chemoprophylaxis in patients with head and neck cancer admitted for more than 72 hours after surgery, which is in line with the American College of Chest Physicians and the American Society of Clinical Oncology recommendations that patients with cancer undergoing surgery should receive VTE prophylaxis for 1 month after surgery. Future prospective studies need to also assess the risk of routine anticoagulation after head and neck cancer surgery to help better define the risk-benefit ratio of routine postoperative pharmacologic chemoprophylaxis.

Clinical Topics: Noninvasive Imaging, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine

Keywords: Incidence, Blood Coagulation, Chemoprevention, Cardiology, Pulmonary Embolism, Venous Thromboembolism, Diagnostic Imaging, Medical Oncology, Risk Assessment, Hemorrhage, United States


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