2022-RA-933-ESGO Risk of venous thromboembolism and major bleeding in gynaecological cancer surgery: series of systematic reviews and meta-analyses

• Published in: International journal of gynecological cancer Vol. 32; no. Suppl 2; pp. A196 - A197
• Main 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
• Format: Journal Article
• Language: English
• Published: Oxford BMJ Publishing Group Ltd 20.10.2022; BMJ Publishing Group LTD
• Subjects: Cancer surgery; Gynecological cancer; Gynecology; Hysterectomy; Miscellaneous; Thromboembolism
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1136/ijgc-2022-ESGO.420

Introduction/BackgroundPharmacological 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.MethodologyWe 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.ResultsWe 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).Abstract 2022-RA-933-ESGO Table 14-week postoperative risk of symptomatic venous thromboembolism (VTE) and bleeding requiring reoperation (BRR) after certain gynaecological cancer proceduresAbstract 2022-RA-933-ESGO Table 24-week postoperative risk of symptomatic venous thromboembolism (VTE) and bleeding requiring reoperation (BRR) after hysterectomy for malignant diseaseConclusionOur 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.