2022-RA-933-ESGO Risk of venous thromboembolism and major bleeding in gynaecological cancer surgery: series of systematic reviews and meta-analyses. (20th October 2022)

• Record Type: Journal Article
• Authors: Lavikainen, Lauri I; Guyatt, Gordon; Luomaranta, Anna L; Cartwrigth, Rufus; Kalliala, Ilkka EJ; Couban, Rachel J; Aaltonen, Riikka L; Aro, Karoliina M; Cárdenas, Jovita L; Devereaux, PJ; Galambosi, Päivi J; Ge, Fang Zhou; Halme, Alex LE; Haukka, Jari; Izett-Kay, Matthew L; Joronen, Kirsi M; Karjalainen, Päivi K; Khamani, Nadina; Nystén, Carolina; Oksjoki, Sanna M; Pourjamal, Negar; Singh, Tino; Tähtinen, Riikka M; Vernooij, Robin WM; Violette, Philippe D; Tikkinen, Kari AO
• Is Part Of: International journal of gynecological cancer. Volume 32(2022)Supplement 2
• Page Start: A196
• Page End: A197
• Publication Date: 2022-10-20
• Subjects: Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2022-ESGO.420
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Introduction/Background: Pharmacological thromboprophylaxis involves balancing lower risk of venous thromboembolism (VTE) against higher risk of bleeding, a trade-off that critically depends on VTE and bleeding risks in the absence of prophylaxis (baseline risk). Baseline risks likely vary between procedures, but their magnitude remains uncertain. At least in part due to uncertainty regarding baseline risks in gynaecological cancer surgery, thromboprophylaxis practices vary substantially within and between countries. Methodology: We conducted comprehensive searches on Embase, MEDLINE, Web of Science, and Google Scholar. We identified observational studies reporting symptomatic VTE or major bleeding (bleeding requiring reoperation, bleeding leading to transfusion, or Hb <70g/L) after gynaecological cancer surgery. Furthermore, we performed separate searches for randomised trials addressing effects of thromboprophylaxis and conducted a web-based survey on thromboprophylaxis practice. We adjusted the reported risk estimates for thromboprophylaxis and follow-up length to determine baseline cumulative incidence at 4 weeks post-surgery for each procedure. We stratified VTE risk by patient risk factors as low (no patient risk factors), medium (age >75, BMI >35, or VTE in a 1st degree relative), or high (any combination or personal VTE history). We used the GRADE approach to rate evidence certainty. Results: We identified 7, 556 titles and abstracts, of which 188 proved eligible, reporting on 37 gynaecological cancer surgery procedures. The quality of evidence was generally very low or low. 4-week risks of major bleeding and especially of VTE varied widely between procedures, and between approaches within the same procedure (tables 1–2). Conclusion: Our results suggest that extended thromboprophylaxis is warranted in many gynaecological cancer procedures, such as ovarian cancer surgery, total hysterectomy with lymphadenectomy and radical hysterectomy. In some procedures, such as laparoscopic total hysterectomy without lymphadenectomy, the risks of VTE and bleeding are closely balanced. In these cases, decisions depend on individual risk prediction and patient values and preferences.