Incidence and prevention of venous thromboembolism in patients undergoing breast cancer surgery and treated according to clinical pathways
Incidence and prevention of venous thromboembolism in patients undergoing breast cancer surgery and treated according to clinical pathways
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DOI：
10.1097/01.sla.0000193832.40178.0a
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发表时间：
2006-01-01
影响因子：
9
通讯作者：
Kuerer, HM
中科院分区：
文献类型：
--
作者：
Andtbacka, RHI;Babiera, G;Kuerer, HM
目的：为了最大限度地减少治疗差异，我们对所有接受手术的乳腺癌患者实施了临床路径。我们试图确定术后静脉血栓栓塞症（VTE）的发病率在这些pathways.Summary背景资料：癌症患者有一个高凝状态，因为静脉血栓栓塞症的风险增加。乳腺癌手术后静脉血栓栓塞的风险还没有得到很好的确定。方法：我们回顾性分析了前瞻性收集的所有患者的数据，这些患者接受了乳腺癌手术，并在2000年1月至2003年9月期间在术后期间接受了机械抗栓塞器械和早期amplification的临床路径治疗。在研究期间，3898名患者接受了4416例外科手术。确定了7例术后60天内发生VTE的患者，每例手术的发生率为0.16%。6例患者仅表现为深静脉血栓形成或肺栓塞; 1例患者两者兼有。从手术到诊断VTE的中位时间为14天（范围：2-60天;平均22天）。乳腺癌的分期或乳房手术类型与静脉血栓栓塞的发生之间没有关系。7例VTE患者中有2例（29%）接受了新辅助化疗。VTE治疗包括皮下低分子量肝素（n = 5）或静脉肝素（n = 2），随后华法林。结论：乳腺癌手术后静脉血栓栓塞是罕见的，在临床路径与机械抗栓塞设备和早期amberment在术后期间治疗的患者。我们的结论是，系统性静脉血栓栓塞预防不适用于这组患者。
Objective: To minimize treatment variations, we have implemented clinical pathways for all breast cancer patients undergoing surgery. We sought to determine the incidence of postoperative venous thromboembolism (VTE) in patients treated on these pathways.Summary Background Data: Cancer patients have an increased risk of VTE because of a hypercoagulable state. The risk of VTE following breast cancer surgery is not well established.Methods: We retrospectively reviewed prospectively collected data for all patients who underwent breast cancer surgery and were treated on the clinical pathways with mechanical antiembolism devices and early ambulation in the postoperative period between January 2000 and September 2003.Results: During the study period, 3898 patients underwent 4416 surgical procedures. Seven patients with postoperative VTE within 60 days were identified, for a rate of 0.16% per procedure. Six patients presented with only a deep venous thrombosis or a pulmonary embolism; 1 patient had both. The median time from surgery to diagnosis of VTE was 14 days (range, 2-60 days; mean, 22 days). No relationship was identified between stage of breast cancer or type of breast surgery and development of VTE. Two (29%) of the 7 patients with VTE had received neoadjuvant chemotherapy. VTE treatment consisted of subcutaneous low-molecular-weight heparin (n = 5) or intravenous heparin (n = 2) followed by warfarin. There were no deaths.Conclusions: VTE following breast cancer surgery is rare in patients who are treated on clinical pathways with mechanical antiembolism devices and early ambulation in the postoperative period. We conclude that systemic VTE prophylaxis is not indicated in this group of patients.