Faculty Collaboration Database

Considerations for pharmacologic thromboprophylaxis following inpatient brachytherapy for gynecologic malignancies. Brachytherapy 2023;22(5):630-639

Date

07/03/2023

Pubmed ID

37394350

Pubmed Central ID

PMC10757857

DOI

10.1016/j.brachy.2023.06.002

Scopus ID

2-s2.0-85164349084 (requires institutional sign-in at Scopus site)

Abstract

PURPOSE: Brachytherapy irradiation carries risks of both bleeding and venous thromboembolism (VTE). No screening or management recommendations for VTE in this setting have been developed. Our study aims to understand the incidence of VTE, compile published anticoagulation guidelines, and call for future guidelines to address thromboprophylaxis in this population.

METHODS AND MATERIALS: A retrospective, single institution study of patients undergoing brachytherapy irradiation between 2012 and 2022 was undertaken. We analyzed 2 cohorts: 87 patients undergoing brachytherapy with an inpatient admission, and 66 patients assessed for risk of VTE or bleeding after discharge from an inpatient admission for brachytherapy. Caprini risk scores were calculated for each patient, and statistical analyses were performed.

RESULTS: Eighty-seven patients were included, and 25% had a VTE diagnosis. Forty-seven (54%) of patients included underwent brachytherapy as definitive treatment of cervical cancer, and 16 (18%) received brachytherapy irradiation to treat recurrent endometrial cancer. In the cohort of 66 patients assessed for risk of VTE or bleeding after brachytherapy discharge, 23 (34.8%) were discharged with thromboprophylaxis, and 43 (65.2%) were discharged without thromboprophylaxis. None of the patients discharged on thromboprophylaxis were diagnosed with a VTE within 90 days of discharge after brachytherapy, whereas 3 of 43 (7%) discharged without thromboprophylaxis were diagnosed with a VTE, OR and 95% CI: 0.25 (0.01-5.29), p = 0.37. Of the 23 patients discharged on thromboprophylaxis, 1 was readmitted for bleeding OR and 95% CI: 5.8 (0.22-155.18), p = 0.29. The median Caprini score was 11.

CONCLUSIONS: VTE is a common occurrence in patients undergoing brachytherapy. Patients undergoing brachytherapy irradiation who require inpatient admission represent a unique population, and specialty organizations should develop consensus recommendations to address these clinical challenges.

Author List

McAlarnen LA, Small C, Tostrud L, Pan AY, Erickson B, Bedi M, Bradley WH

Authors

Manpreet Bedi MD, MS Professor in the Radiation Oncology department at Medical College of Wisconsin
William H. Bradley MD Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Amy Y. Pan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anticoagulants
Brachytherapy
Female
Genital Neoplasms, Female
Hemorrhage
Humans
Inpatients
Neoplasm Recurrence, Local
Postoperative Complications
Retrospective Studies
Risk Factors
Venous Thromboembolism