title: Venous thromboembolism (VTE) rates following the implementation of extended duration prophylaxis for patients undergoing surgery for gynecologic malignancies.
abstract: OBJECTIVE
  To compare the incidence of venous thromboembolism (VTE) before and after the implementation of standardized extended duration prophylaxis guidelines in women undergoing laparotomy for gynecologic cancer.
  
  
  METHODS
  In October 2009, departmental practice guidelines were implemented for VTE prevention. Patients undergoing laparotomy for gynecologic cancer were started on low molecular weight heparin (LMWH) within 24h of surgery and it was continued for a total of 28 days postoperatively. The incidence of VTE diagnosed within 30 and 90 days of surgery was determined and compared to a historic cohort of patients who underwent surgery prior to implementation of the guidelines.
  
  
  RESULTS
  The incidence of VTE within 30 days of surgery decreased from 2.7% (8/300) to 0.6% (2/334) following implementation of VTE prevention guidelines (78% reduction, p=0.040). However, when the pre and post-guideline implementation groups were compared for the development of VTE within 90 days of surgery, there was no significant difference (11/300 (3.7%) vs. 10/334 (3.0%) respectively, p=0.619). The median time between surgery and VTE diagnosis was 12 days in the pre-guideline implementation group, compared with 57 days in the post-guideline implementation group (p=0.012).
  
  
  CONCLUSIONS
  Patients receiving extended duration LMWH were found to have significantly lower rates of VTE within 30 days of surgery when compared with similar patients who did not receive extended duration LMWH. However, this effect was not sustained when the groups were compared for VTE diagnosis within 90 days of surgery. Additional study is needed to further reduce long-term VTE rates in this high-risk population.
authors.affiliation: Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. kschmele@mdanderson.org
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Ginger L
authors.initials: GL
authors.lastname: Wilson
authors.forename: Katherine
authors.initials: K
authors.lastname: Cain
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Alpa M
authors.initials: AM
authors.lastname: Nick
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kroll
authors.forename: Charles F
authors.initials: CF
authors.lastname: Levenback
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000097:blood* / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D006495:Heparin, Low-Molecular-Weight