Thromboprophylaxis does more harm than good in head and neck surgery

By Sally Robertson, B.Sc.Jan 2 2013

Patients undergoing oncologic head and neck surgery do not benefit from thromboprophylaxis, report researchers.

In a study of 1018 patients, receiving thromboprophylaxis during surgery had no impact on the rate of venous thromboembolic (VTE) events, with no events occurring in any patient within the trial.

In fact the analysis showed higher rates of morbid side effects with the use of thromboprophylaxis, report Haim Gavriel (Peter MacCallum Cancer Institute, Melbourne, Australia) and colleagues who suggest its use should be limited to individuals who are at high risk for thromboembolism.

"Because extensive evidence from other surgical specialties over the last several years indicated that thromboprophylaxis was of benefit in preventing VTE events in oncologic surgeries, a decision was made at the Surgical Oncology Department at our institution to treat all patients with cancer undergoing surgery with chemoprophylaxis starting from August 1, 2007," explains the team.

As there is a paucity of data evaluating the effects of thromboprophylaxis on the incidence of VTE events in head and neck cancer patients, the team compared events in patients who underwent surgery between January 2005 and August 2007 (n=450) with those who underwent surgery between August 2007 and March 2010 (n=568).

As reported in Head and Neck, no patients in either group had a deep vein thrombosis or pulmonary embolism throughout the study period, giving a VTE rate of 0% across the entire cohort.

However, 12 patients developed postoperative hematoma, or bleeding from the surgical site, only one of whom was from the group of patients who did not receive thromboprophylaxis. The other 11 patients received the low-molecular-weight heparin, enoxaparin or heparin and 10 were treated with thromboprophylactic stockings.

"The VTE rates in our patients were significantly lower than the rates reported in the literature for other surgical specialties," say the researchers, who suggest this may be due to early mobilization of head and neck surgery patients within a day, unlike general surgical or orthopedic patients in whom mobilization is often limited for a longer term."

The team also points out that although there is a clear increase in bleeding complications with thromboprophylaxis use in other surgical specialties, the risk for bleeding is generally more than balanced by the reduction in the high rates of VTE events observed when anticoagulation is not used.

However, "given that the rate of side effects of chemoprophylaxis in our cohort had more significance than the rates of VTE, we conclude that chemoprophylaxis was of no proven benefit in patients with oncologic head and neck surgery," say Gavriel et al.

"Its use should be limited to high-risk patients such as those with thromboembolic problems, where delayed mobilization after surgery is anticipated or where microvascular reconstructive surgery is used," they conclude.

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