Professor Feras Abu Saadeh

Summary

Venous thromboembolism (VTE) is a common cause of death in patients with solid tumours. Cancer itself causes a hypercoagulable state, in addition chemotherapy and surgery enhance the risk. Gynaecological cancers have been associated with high rates of VTE which is excacerbated by pelvic surgery and chemotherapy. A recent study in our centre showed that one third of VTE in ovarian cancer patients occurs within 5 days of surgery despite heparin prophylaxis. Recently, clinical risk models have been developed to predict VTE in patients undergoing chemotherapy, these models have been shown to be more powerful when combined with haemostatic biomarkers. Thrombus formation is complex in cancer and is thought to result from a release of procoagulant material from the tumour combined with damage to the endothelium as a result of chemotherapy and surgery. Global tests of hypercoagulability which capture these effects are therefore attractive as determinants of thrombotic risk. Calibrated automated thrombograpy (CAT) is a recently developed global test which measures thrombin generation in plasma. Increased thrombin generation is predictive of VTE in a variety of clinical settings. The overarching aim of this project is to develop and validate a specific risk scoring model for VTE risk in gynaecological cancer patients using a combination of easily available clinical and laboratory parameters and haemostatic biomarkers. In a large population of gynaecological cancer patients, we will identify the key risk factors for VTE and use them to derive a risk score model. Based on our pilot data, we believe that a thrombin generation test may be a useful biomarker for VTE in gynaecological cancer. By understanding the mechanisms by which gynaecological cancer increases procoagulant activity, we will optimise a specific thrombin generation assay which when combined with the derived risk score model will accurately identify gynaecological cancer patients at high risk of VTE.

Funding Agency

HRB

Summary

A recent survey of patients who suffered a thrombosis during their cancer journey showed that, generally, patients are not warned about the risk of clots during cancer and are not told what to look out for. In addition research by our group has shown that only 45% of gynaecologists in Europe are using the correct guidelines for thrombosis prevention. The aim of this project is to increase awareness among patients regarding thrombosis and to provide an opportunity for knowledge exchange between gynaecologist and scientists working in the area

Funding Agency

HRB

Summary

Venous thromboembolism (VTE) is a common post-operative complication in cancer patients associated with high mortality rates. The presence of a gynaecological malignancy increases the rate of post operative VTE fourfold compared with patients with benign disease. Among cancer patients who develop a venous thromboembolism postoperatively, 40% will do so 21 days after surgery(1). Among endometrial cancer patients diagnosed with venous thromboembolism, a recent study of a large national quality database found that 73% of minimally invasive surgery and 43% of open surgery patients are diagnosed with a venous thromboembolism after hospital discharge (2). In line with these findings, the American College of Chest Physicians recommends the use of extended duration prophylaxis for patients with cancer undergoing abdomino-pelvic surgery (3). From May 2012, all patients undergoing surgery for a gynaecological malignancy in our centre receive 28 days extended LMWH prophylaxis post surgery. Studies in other centres have reported that translation of the guidelines for prophylaxis into clinical practice has been problematic (4). Introduction of extended prophylaxis is an additional burden on the cancer patient as they are responsible for purchasing, and in many cases, self-injecting the medication. Additional educational and support services are also required in the community for these patients. In other patient groups, lack of education and a negative opinion toward injection has affected compliance (5). The cancer patient may have additional difficulty as they are managing multiple symptoms and treatments. Among gynaecological cancer patients, the patient experience of extended prophylaxis has not been documented and compliance is largely unknown.

Funding Agency

LeoPharma

Summary

Gynaecological cancers, and in particular adenocarcinomas are associated with a very high risk of venous thromboembolism (VTE) with rates as high as 42% reported for clear cell cancer of the ovary . Patients are particularly at risk during the postoperative period where VTE occurs in 6-7% of patients despite LMWH prophylaxis. In addition, recent evidence has suggested that a substantial proportion of VTE occurs beyond hospital stay. Among gynaecological cancer patients who develop VTE, 40% occur > 21 days post surgery . Minimally invasive surgery is increasingly used for gynaecological cancer surgery, although this has significantly reduced the incidence of VTE, it has not eliminated this risk post surgery [4. Among patients who suffer a VTE following minimally invasive surgery for endometrial cancer, 73% were diagnosed with a VTE after discharge compared with 43% for open surgery patients. The mean time to VTE was 10 days for minimally invasive surgery and 14 days for open surgery patients. A randomised trial comparing 28 days prophylaxis with LMWH following major abdominal surgery for cancer with 7 days prophylaxis showed a 60% reduction in VTE in the extended prophylaxis group without any substantial risk of bleeding.

Funding Agency

LeoPharma

Summary

Gynaecological cancer is associated with an increased incidence of venous thromboembolism (VTE) even with appropriate thromboprophylaxis. The risk is greatest following surgery and can persist for up to 6-12 months post surgery. The focus of our research group is to determine clinical and haemostatic biomarkers for VTE post surgery in order to identify high risk gynaecological cancer patients who may benefit from more tailored LMWH prophylaxis Lymph node dissection (LND) is a common procedure in gynaecological cancer surgery and increases the complications and complexity of the surgery. Reports in other cancers suggest an association between lymph node metastasis and post operative thrombo embolic complications. However there is very little data on gynaecological cancers. In addition, none of the current risk scores for thrombosis account for LND, The aim of our study is to investigate the role of lymph node metastasis in VTE following both open and laparoscopic surgery for gynaecological cancer.

Funding Agency

LeoPharma