High VTE Risk Seen After Complex Head and Neck Cancer Surgery

October 02, 2013

By Will Boggs, MD

NEW YORK (Reuters Health) Oct 02 - Patients who undergo surgery for head and neck cancer have an increased risk of venous thromboembolism (VTE), according to a new study.

"The risk of VTE among head and neck cancer patients having complex surgery is much higher than previously reported," Dr. Neil Gross from Oregon Health and Science University in Portland told Reuters Health. "Based on this study, we now recommend routine VTE chemoprophylaxis for the same population that was included in the study (head and neck cancer patients having surgery with expected hospitalization > 4 days)."

Earlier retrospective studies by Dr. Gross's group showed the incidence of VTE in high-risk patients undergoing head and neck cancer surgery to range from 1.4% (confirmed) to 5.8% (confirmed and suspected).

For the new study, Dr. Gross and colleagues prospectively investigated the incidence of VTE following head and neck cancer surgery in 100 patients who had an expected postsurgical hospital stay of at least four days. All patients underwent daily clinical examinations and bilateral lower extremity venous duplex ultrasonographic examination on postoperative day two or three.

Most patients had moderate to high risk for VTE based on the Caprini VTE risk assessment, according to the report, online September 26 in JAMA Otolaryngology -- Head & Neck Surgery.

The overall incidence of VTE was 13%, including five asymptomatic superficial VTEs (deemed non-clinically significant) and eight symptomatic superficial VTEs, deep vein thromboses, or pulmonary emboli (deemed clinically significant). Only four of the clinically significant VTEs provoked any signs or symptoms.

Patients who developed VTE tended to have lower mean Karnofsky performance scores and higher Caprini risk assessment scores, but none of the risk factors evaluated showed statistically significant differences.

Fourteen patients received postoperative anticoagulation (excluding those treated for a VTE), and only one VTE was observed among these patients.

There were significantly more bleeding complications among patients receiving anticoagulation than among patients not receiving anticoagulation (29% vs. 5%, p=0.01).

"Routine postoperative chemoprophylaxis for VTE is rapidly becoming standard practice across many surgical disciplines," the researchers note. "Head and neck surgeons have been slower to apply the use of routine postoperative anticoagulation possibly out of fear of bleeding complications."

"We are now conducting a follow-up prospective study in the same population to determine how effective chemoprophylaxis is at reducing VTE and to determine the possible bleeding complications attributable to VTE chemoprophylaxis," Dr. Gross said.

SOURCE: http://bit.ly/1bv9gRY

JAMA Otolaryngol Head Neck Surg 2013.

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