The incidence of haemorrhagic and thromboembolic events after breast cancer surgery in patients treated with pharmacological thromboprophylaxis

Abstract

Background. Hemorrhagic events and venous thromboembolic disease, including pulmonary embolism and deep venous thrombosis, are the most important complications after breast cancer surgery. Although hemorrhagic complications are not usually severe and do not have a high mortality risk, venous thromboembolic disease is often associated with high morbidity and mortality rates. Under such circumstances, it is highly important to evaluate the need for systemic antithrombotic prophylaxis as opposed to mechanical interventions and the optimal duration of chemoprophylaxis in patients undergoing breast cancer surgery. Methods. Using the database of the General Surgery Department of “Colţea” Clinical Hospital, we analyzed the data from 2015 to 2018. During this period, pharmacological prophylaxis was used in all patients undergoing breast cancer surgery. Mechanical prophylaxis (intermittent pneumatic compression or graduated compression) has also been recommended, but there was no record of patient compliance. The primary outcome was the occurrence of venous thromboembolic or hemorrhagic events within 30 days after surgery. Results. In our institution, the venous thromboembolic disease rate for breast cancer surgery was 4/540 (0.7%; 95% CI: 0.02-1.9%), being similar to that of other studies. Hemorrhagic events occurred in 29 (5.4%; 95% CI 3.6-7.6%) patients, most commonly as hematoma in 3.3% of the patients. The incidence of hematoma requiring operation was 1.1% (95% CI: 0.4-2.4%), while hematoma treated conservatively was 2.2% (95% CI:1.2-3.8%). Other forms of hemorrhagic events include hemorrhagic drainage and bleeding wound, occurring in 2.0% of the cases. Conclusions. The occurrence of venous thromboembolic events is reduced among patients undergoing primary breast cancer surgery. A current issue is decreasing venous thromboembolic disease rates without increasing the hemorrhagic event rate. Standard guidelines on the antithrombotic prophylaxis of these patients are not well established since studies show contradictory data. Further investigations are needed to determine exactly which type of thromboprophylaxis is more effective.

Keywords

• breast cancer
• venous thromboembolism
• haemorrhagic complications
• risk factors
• epidemiology