Does peri-operative administration of anticoagulant therapy improve outcomes in patients having surgery for head and neck cancer?
Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are severe complications in patients undergoing surgery. For reasons that have never been elucidated, however, patients having head and neck oncologic surgery seem to experience lower rates of both DVT and PE. The surgical care improvement program (SCIP) encourages some form of prophylaxis for all patients having surgery. The risk of DVT varies with patient age, the presence of malignancy, and the type of surgery. These authors sought to once again test the hypothesis that some benefit might be generated by anticoagulation administered for patients having surgery for head and neck cancer.
Explore this issue:January 2014
Study design: Retrospective study.
Setting: Peter MacCallum Cancer Centre, Melbourne, Australia.
Synopsis: Between January 1, 2005, and March 3, 2010, 1,018 patients underwent major oncologic head and neck surgery. Outpatients were excluded, and no patient had free flap reconstruction. Chemoprophylaxis was administered to 450 patients, while 568 received no anticoagulation. Most patients in both groups received mechanical prophylaxis (leg compression). The rate of DVT was 0%. Hematoma or surgical site bleeding was identified in 12 patients, of whom 11 were in the group that received anticoagulation.
Bottom line: The low rate of DVT in patients having oncologic head and neck surgery suggests anticoagulation on a routine basis is not necessary. Routine use of leg compression is endorsed.
Citation: Gavriel H, Thompson E, Kleid S, Chan S, Sizeland A. Safety of thromboprophylaxis after oncologic head and neck surgery. Head Neck. 2013;35:1410-1414.