title: Venous thromboembolism prophylaxis during neoadjuvant therapy for resectable and borderline resectable pancreatic cancer-Is it indicated?
abstract: OBJECTIVE
  To describe venous thromboembolism (VTE) rates in patients with pancreatic cancer (PC) during neoadjuvant therapy.
  
  
  METHODS
  Factors associated with VTE were evaluated using multivariable logistic regression modeling in patients with resectable and BLR PC treated with neoadjuvant therapy between 2009 and 2014.
  
  
  RESULTS
  Prevalent VTEs were detected in 13 (5%) of the 260 patients. Incident VTEs were detected in 26 patients (10%); 9 (8%) of the 109 resectable and 17 (11%) of the 151 BLR patients (P = 0.53). Of the 26 incident events, 9 (35%) were PEs, 9 (35%) were extremity DVTs, and 8 (31%) involved the SMV/PV. VTEs were catheter-related in 7 (27%) of the 26 patients. Rh(D) antigen positivity was associated with a decreased risk of incident VTE (OR:0.32, 95%CI:0.11-0.85, P = 0.02). Completion of neoadjuvant therapy to include surgery occurred in 176 (75%) of the 234 patients without incident VTE as compared to 14 (54%) of the 26 patients with incident VTE (P = 0.02). The median survival for all 260 patients was 24.3 months: 17.0 months versus 24.6 months for patients who did and did not develop incident VTE during neoadjuvant therapy (P = 0.11).
  
  
  CONCLUSIONS
  Patients with localized PC who receive neoadjuvant therapy are at significant risk of VTE and thromboprophylaxis may be warranted. J. Surg. Oncol. 2016;114:581-586. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ashley N
authors.initials: AN
authors.lastname: Krepline
authors.affiliation: Department of Surgery, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.affiliation: Department of Medicine, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ben
authors.initials: B
authors.lastname: George
authors.affiliation: Department of Medicine, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Ritch
authors.affiliation: Department of Radiation Oncology, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Erickson
authors.affiliation: Department of Radiology, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Parag
authors.initials: P
authors.lastname: Tolat
authors.affiliation: Department of Surgery, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.affiliation: Department of Surgery, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, Wisconsin. stsai@mcw.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018579:Patient Selection; D015995:Prevalence; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000970:Antineoplastic Agents
keywords: neoadjuvant therapy; pancreatic cancer; venous thromboembolism