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Incidence and Timing of Thromboembolic Events in Patients With Ovarian Cancer Undergoing Neoadjuvant Chemotherapy

Greco, Patricia S. MD; Bazzi, Ali A. MD; McLean, Karen MD, PhD; Reynolds, R. Kevin MD; Spencer, Ryan J. MD; Johnston, Carolyn M. MD; Liu, J. Rebecca MD; Uppal, Shitanshu MBBS

doi: 10.1097/AOG.0000000000001980
Contents: Original Research

OBJECTIVE: To identify the incidence and timing of venous thromboembolism as well as any associated risk factors in patients with ovarian, fallopian tube, or primary peritoneal cancer undergoing neoadjuvant chemotherapy.

METHODS: We conducted a retrospective cohort study of patients diagnosed with ovarian, fallopian tube, and primary peritoneal cancer and receiving neoadjuvant chemotherapy from January 2009 to May 2014 at a single academic institution. The timing and number of venous thromboembolic events for the entire cohort were categorized as follows: presenting symptom, during neoadjuvant chemotherapy treatment, after debulking surgery, and during adjuvant chemotherapy.

RESULTS: Of the 125 total patients with ovarian cancer undergoing neoadjuvant chemotherapy, 13 of 125 patients (10.4%, 95% confidence interval [CI] 6.1–17.2%) had a venous thromboembolism as a presenting symptom and were excluded from further analysis. Of the 112 total patients at risk, 30 (26.8%, 95% CI 19.3–35.9%) experienced a venous thromboembolism. Based on the phase of care, 13 (11.6%, 95% CI 6.8–19.1%) experienced a venous thromboembolism during neoadjuvant chemotherapy, six (5.4%, 95% CI 2.4–11.5%) developed a postoperative venous thromboembolism, and 11 (9.9%, 95% CI 5.5–17%) developed a venous thromboembolism during adjuvant chemotherapy. Two of the four patients with clear cell histology developed a venous thromboembolism in this cohort.

CONCLUSION: Overall new diagnosis of venous thromboembolism was associated with one fourth of the patients undergoing neoadjuvant chemotherapy for ovarian cancer with nearly half of these diagnosed during chemotherapy cycles before interval debulking surgery. Efforts to reduce venous thromboembolism so far have largely focused on the postoperative period. Additional attention to venous thromboembolic prophylaxis during chemotherapy (neoadjuvant and adjuvant) in this patient population is warranted in an effort to decrease the rates of venous thromboembolism.

One in four patients receiving neoadjuvant chemotherapy developed a new venous thromboembolism during initial treatment and mostly during timeframes when routine prophylaxis is not currently recommended.

Division of Gynecologic Oncology and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, and the Department of Obstetrics and Gynecology, St. John Hospital, Detroit, Michigan; and the Division of Gynecologic Oncology, University of Wisconsin, Madison, Wisconsin.

Corresponding author: Shitanshu Uppal, MBBS, University of Michigan, 1500 E Medical Drive, Ann Arbor, MI 48109; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as a poster at the Annual Meeting on Women's Cancer, Society of Gynecologic Oncology, March 19–22, 2016, San Diego, California.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.