title: Is forgoing chemical venous thromboembolism prophylaxis for women undergoing breast-conserving surgery for breast cancer safe?
abstract: BACKGROUND
  Cancer patients have a 4 to 7 fold increased risk of venous thromboembolism (VTE) vs the normal population. Chest guidelines recommend no chemical VTE prophylaxis for women with a <1.5% risk for VTE. Although the risk of VTE among women undergoing breast-conserving therapy is reported to be low overall, the rate without chemical prophylaxis has not been defined. The objective of the study was to establish the VTE risk among women undergoing breast-conserving surgery (BCS) who did not receive chemical VTE prophylaxis.
  
  
  METHODS
  From a prospective breast cancer database, 1,000 consecutive patients who underwent BCS without chemical VTE prophylaxis and with mechanical prophylaxis (support hose and intermittent pneumatic compression devices) were analyzed for VTE occurrence within 30 days postoperatively. Institutional review board approval was obtained.
  
  
  RESULTS
  The mean age was 65.4 ± 11.7 years, and mean body mass index was 27.3 ± 5.7. About 81.9% of the patients were postmenopausal. Median tumor size was 1.1 cm, and 24.7% of patients had lymph node metastases. The 30-day rate of clinically significant VTE was 0% (95% CI 0% to .37%). Hematomas requiring surgical intervention occurred among .6% of patients.
  
  
  CONCLUSIONS
  This cohort demonstrates that breast cancer patients undergoing BCS may be safely managed without chemical VTE prophylaxis because the risk with only mechanical prophylaxis is acceptable.
authors: Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
authors: Samer G
authors: SG
authors: Zammar
authors: Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
authors: Barbara A
authors: BA
authors: Pockaj
authors: Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
authors: Chee Chee
authors: CC
authors: Stucky
authors: Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
authors: Nabil
authors: N
authors: Wasif
authors: Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. Electronic address: Gray.richard@mayo.edu.
authors: Richard J
authors: RJ
authors: Gray
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D053828:Stockings, Compression; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents
keywords: Breast; Cancer; Lumpectomy; Prophylaxis; Thromboembolism; VTE