Is prolonged-duration chemoprophylaxis associated with reductions in venous thromboembolism among high-risk patients with head and neck cancer undergoing oncologic surgery?
In this cohort study of 247 high-risk patients with head and neck cancer, prolonged-duration chemoprophylaxis was independently associated with reductions in venous thromboembolism but increases in nonfatal bleeding events.
The study’s findings indicate that prolonged-duration chemoprophylaxis among patients with head and neck cancer undergoing oncologic procedures may be associated with reductions in perioperative venous thromboembolism; however, the associated increase in nonfatal bleeding events warrants careful consideration and further highlights the importance of determining an optimal duration of chemoprophylaxis among this distinct cohort.
Venous thromboembolism (VTE) is associated with substantial morbidity and is the most common factor associated with preventable death among hospitalized patients. Data from otolaryngologic studies suggest that the risk of VTE may be underestimated among high-risk patients, particularly among those undergoing oncologic procedures. The incorporation of prolonged-duration chemoprophylaxis (PDC) into preventive therapy has been associated with substantial decreases in VTE incidence among patients undergoing oncologic surgery. However, bleeding remains a major concern among otolaryngologists, and substantial variation exists in the use of thromboprophylaxis.
To assess the association between PDC and VTE in high-risk patients with head and neck cancer undergoing oncologic procedures.
Design, Setting, and Participants
This retrospective cohort study identified 750 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. After exclusions, 247 patients were included in the study; patients were divided into 2 cohorts, traditional and PDC, based on the duration of prophylaxis. Univariate and multivariate analyses were performed to examine the development of VTE and bleeding-associated complications during the 30-day postoperative period. Data were analyzed from April 1 to April 30, 2020.
PDC, defined as 7 or more postoperative days of chemoprophylaxis.
Main Outcomes and Measures
VTE and bleeding events during the 30-day postoperative period.
Among 247 patients (mean [SD] age, 63.1 [11.1] years; 180 men [72.9%]) included in the study, 106 patients (42.9%) received traditional prophylaxis, and 141 patients (57.1%) received PDC. The incidence of VTE was 5 of 106 patients (4.7%) in the traditional cohort and 1 of 141 patients (0.7%) in the PDC cohort (odds ratio [OR], 0.15; 95% CI, 0.003-1.33). In the multivariate logistic regression analysis, PDC was independently associated with reductions in the risk of VTE (OR, 0.04; 95% CI, 0.001-0.46). 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; 95% CI, 0.55-217.00).
Conclusions and Relevance
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.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Tipirneni KE, Bauter L, Arnold MA, Audlin JA, Ryan J, Marzouk M. Association of Prolonged-Duration Chemoprophylaxis With Venous Thromboembolism in High-risk Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. 2021;147(4):320–328. doi:10.1001/jamaoto.2020.5151
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: