Head and neck cancers: Prolonged-Chemoprophylaxis reduces VTE risk

Professor Armand Trousseau was the first to write about the association between cancer and thrombosis in 1865, and the combination of the two conditions is still often called Trousseau's syndrome. Venous thromboembolism (VTE) is reported to occur in up to 33% of patients undergoing major vascular surgery. Despite this high incidence, patients inconsistently receive timely VTE chemoprophylaxis. The risk of VTE among patients receiving delayed VTE chemoprophylaxis is unknown. Therefore, researchers of the State University of New York Upstate Medical University, Syracuse, conducted a study to assess the association between prolonged duration chemoprophylaxis (PDC) and VTE in high-risk patients with head and neck cancer undergoing oncologic procedures.

It was a retrospective cohort study in 247 patients with biopsy-confirmed head and neck cancer and a Caprini risk score of 8 or higher who underwent inpatient oncologic surgery at a tertiary care referral center between January 1, 2014, and February 1, 2020. Researchers divided the patients into 2 cohorts, traditional (n=106) and PDC (141), based on the duration of prophylaxis. They performed univariate and multivariate analyses to examine the development of VTE and bleeding-associated complications during the 30-day postoperative period. The major outcome assessed was the VTE and bleeding events during the 30-day postoperative period.

The researchers noted that the incidence of VTE was 5 of 106 patients in the traditional cohort and 1 of 141 patients (0.7%) in the PDC cohort (odds ratio [OR], 0.15). Upon multivariate logistic regression analysis, they found that PDC was independently associated with reductions in the risk of VTE. They noted that the incidence of bleeding events was 1 of 106 patients (0.9%) in the traditional cohort and 6 of 141 patients (4.3%) in the PDC cohort (OR, 4.64).

The authors concluded, "The use of chemoprophylaxis for high-risk patients with head and neck cancer remains a high-priority topic. The results of this study suggest that PDC may be associated with reductions in VTE among this patient population. However, the associated increase in nonfatal bleeding events warrants careful consideration and further highlights the need to determine an optimal duration for chemoprophylaxis among this distinct cohort".

For further information:

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2775066