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Venous Thromboembolism in Patients with Primary Bone or Soft-Tissue Sarcomas

Mitchell, Sheryl Y. BSc; Lingard, Elizabeth A. MPH; Kesteven, Patrick MB, FRACP; McCaskie, Andrew W. MB, FRCS(Tr&Orth); Gerrand, Craig H. MB ChB, FRCSEd(Tr&Orth)

Journal of Bone & Joint Surgery - American Volume: November 2007 - Volume 89 - Issue 11 - p 2433–2439
doi: 10.2106/JBJS.F.01308
Scientific Articles

Background: Venous thromboembolism has been independently associated with both malignant disease and orthopaedic surgery. Patients with bone or soft-tissue tumors who undergo orthopaedic surgery may therefore be at high risk for thromboembolic events. The purpose of the present retrospective study was to determine the rate of clinically detected deep venous thrombosis and pulmonary embolism in patients with trunk or extremity bone or soft-tissue sarcomas.

Methods: The medical records of patients with a confirmed diagnosis of primary bone or soft-tissue sarcoma who had presented to our unit between 1998 and 2003 were reviewed with use of a standardized chart abstraction tool. The data that were retrieved included patient-related data (demographic characteristics, diagnoses, and surgical interventions), the use of adjuvant chemotherapy or radiation therapy, additional risk factors for thromboembolism, the use of thromboembolic prophylaxis, and confirmed thromboembolic events.

Results: Of the 252 patients who were identified, ninety-four had a diagnosis of primary bone sarcoma and 158 had a diagnosis of primary soft-tissue sarcoma. Approximately 70% of the cohort received thromboprophylaxis, with 57% receiving low-molecular-weight heparin. Thirty-seven patients were clinically suspected of having a deep venous thrombosis. Nine patients had a deep venous thrombosis that was confirmed radiographically, and in one case the diagnosis was made at another center, resulting in a rate of clinically evident deep venous thrombosis of 4%. Nine patients had a clinically suspected pulmonary embolism. One patient had confirmation of the pulmonary embolism with use of a ventilation-perfusion scan, one patient died of pulmonary embolism, and one patient had diagnosis of the pulmonary embolism at another center, resulting in an overall rate of pulmonary embolism of 1.2% and a rate of fatal pulmonary embolism of 0.4%. All patients with thromboembolic events had a tumor involving the hip or thigh, with the majority of the events occurring prior to definitive surgery.

Conclusions: The risk of a clinically apparent thromboembolic event in patients with bone or soft-tissue sarcomas is comparable with that in other orthopaedic patients. However, tumors in the hip or thigh may be associated with a particularly high risk of thromboembolism. A prospective study is needed to investigate factors that are predictive of thromboembolism and the role of chemical thromboprophylaxis.

Level of Evidence: Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

1 Departments of Orthopaedics (S.Y.M. and C.H.G.) and Haematology (P.K.), Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, England. E-mail address for S.Y. Mitchell: sheryl.Mitchell@nuth.northy.nhs.uk

2 School of Surgery and Reproductive Sciences, The Medical School, University of Newcastle, Framlington Place, Newcastle Upon Tyne, NE2 4HH, England

Copyright 2007 by The Journal of Bone and Joint Surgery, Incorporated
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