Thromboembolism in patients with Gyn tumors: risk factors, natural history, and prophylaxis

Venous thromboembolism is a frequent major complication in patients with gynecologic cancer. Risk factors include being elderly and nonwhite, having an advanced stage of malignancy, a past history of deep venous thrombosis, previous venous disease as evidenced by lower extremity edema, venous stasis changes, or varicose veins. Patients who have had pelvic radiation therapy, or who are more than ten percent over their ideal body weight are also at increased risk. Thromboembolism in gyn cancer patients most often occurs in the perioperative period. Prevention is dependent upon the recognition of the patient at risk and institution of effective prophylactic methods, prior to surgery, and continuing until the patient is fully ambulatory. Low-dose heparin postoperatively is ineffective, but more intense regimens of heparin and intermittent leg compression in the operating room and postoperatively are effective.