title: Prescription of extended-duration thromboprophylaxis after high-risk, abdominopelvic cancer surgery.
abstract: Extended-duration thromboprophylaxis for 4weeks after discharge has been demonstrated to reduce venous thromboembolic events (VTE) in cancer patients undergoing abdominopelvic surgery and is recommended in national guidelines. We examined the utilization and effectiveness of extended-duration low molecular weight heparin prophylaxis in high-risk cancer patients.
  
  
  
  We analyzed patients with colon, ovarian, and uterine cancer who underwent surgery from 2009 to 2013 and who were recorded in the MarketScan database. Multivariable models and propensity score analysis with inverse probability of treatment weight were developed to examine uptake and predictors of use of post-discharge low molecular weight heparin (LMWH), as well as associated adverse events (transfusion, and hemorrhage).
  
  
  
  A total of 63,280 patients were identified. Use of extended-duration prophylaxis increased from 2009 to 2013 from 1.4% to 1.7% (P=0.67) for colectomy, 5.9% to 18.3% for ovarian cancer surgery (P<0.001), and 6.3% to 12.2% (P<0.001) for hysterectomy for endometrial cancer. There was no association between use of extended-duration prophylaxis and reductions in VTE for any of the procedures: colectomy (2.4% with extended-duration prophylaxis vs. 2.9% without prophylaxis, OR=0.84; 95% CI, 0.54-1.31), ovarian cancer-directed surgery (3.7% vs. 3.6%, OR=1.01; 95% CI, 0.76-1.33), hysterectomy (2.1% vs. 2.1%; OR=0.96; 95% CI, 0.67-1.38). Extended-duration prophylaxis was associated with an increased risk of adverse postoperative events: 2.20 (95% CI, 1.51-3.19) after colectomy, 1.24 (95% CI, 0.92-1.68) following ovarian cancer-directed surgery and 0.99 (95% CI, 0.66-1.48) for hysterectomy for endometrial cancer.
  
  
  
  Use of extended-duration thromboprophylaxis is low among high-risk cancer patients undergoing surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, 10032, United States; New York Presbyterian Hospital, New York, NY 10032, United States. Electronic address: jw2459@columbia.edu.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.
authors.forename: Soledad
authors.initials: S
authors.lastname: Jorge
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, 10032, United States; New York Presbyterian Hospital, New York, NY 10032, United States.
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 10032, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, 10032, United States; New York Presbyterian Hospital, New York, NY 10032, United States.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, 10032, United States; New York Presbyterian Hospital, New York, NY 10032, United States.
authors.forename: June Y
authors.initials: JY
authors.lastname: Hou
authors.affiliation: New York Presbyterian Hospital, New York, NY 10032, United States; Department of Urology, Weill Cornell Medical College, New York, NY 10065, United States.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, 10032, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 10032, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, 10032, United States; New York Presbyterian Hospital, New York, NY 10032, United States.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 10032, United States.
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, 10032, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 10032, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, 10032, United States; New York Presbyterian Hospital, New York, NY 10032, United States.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003110:Colonic Neoplasms / Q000097:blood / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000097:blood / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Heparin; Low molecular weight heparin; Prophylactic; Prophylaxis; Pulmonary embolism; Venous thromboembolism