Metastatic bone disease associated with high risk of VTE after orthopedic surgery
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DALLAS — Presented results found high rates of postoperative venous thromboembolism and low rates of prophylaxis prescriptions in patients who underwent orthopedic surgery for metastatic bone disease of the long bones or pelvis.
“Patients with advanced cancer are known to be hypercoagulable due to alterations in the normal coagulation cascade. In addition to that, many of the chemotherapy agents that we use to treat disease can also make patients hypercoagulable,” Annalise G. Abbott, MD, said in her presentation at the Orthopaedic Research Society Annual Meeting. “Despite this sort of hypothesized increased risk of VTE, there are currently no guidelines to suggest appropriate thromboprophylaxis postoperatively,” she added.
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Abbott and colleagues from the department of surgery at the University of Calgary retrospectively analyzed data on 558 patients (mean age of 67.3 years) who underwent surgery for metastatic bone disease of the long bones or pelvis from 2006 to 2021. According to Abbott, indications for surgery included acute pathologic fracture (61.7%) and impending fracture (38.4%).
They found outpatient thromboprophylaxis was prescribed for 35.5% of patients for a median duration of 30 days. Postoperative VTE rates were 5.7% in the overall cohort and 6% in patients who underwent lower extremity surgery. According to the study abstract, researchers found 24 cases of pulmonary embolism (PE) and 11 cases of deep vein thrombosis. Abbott noted 10 cases of PE and six cases of DVT were found in patients who received thromboprophylaxis.
“We identified three risk factors for developing VTE: the presence of a pathologic fracture as the surgical indication, one or more comorbidity outside of metastatic cancer and then no prescription for thromboprophylaxis,” Abbott said. “From our study we can conclude that thromboprophylaxis is underutilized and may not be appropriate or sufficient for this very high-risk population. So, patient-specific thromboprophylaxis may be indicated or perhaps aspirin in this population,” she concluded.
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Abbott AG, et al. Paper 316. Presented at: Orthopaedic Research Society Annual Meeting; Feb. 10-14, 2023; Dallas (hybrid meeting).
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