Venous Thromboembolism in Peritoneal Mesothelioma: Uncovering the Hidden Risk

• Published in: Annals of surgical oncology Vol. 31; no. 5; pp. 3339 - 3349
• Main Authors: Bansal, Varun V., Mitchell, Owen, Bregio, Celyn, Witmer, Hunter D. D., Dhiman, Ankit, Godley, Frederick A., Ong, Cecilia, Berger, Yaniv, Reddy, Biren, Churpek, Jane E., Drazer, Michael W., Eng, Oliver S., Kindler, Hedy L., Turaga, Kiran K.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2024; Springer Nature B.V
• Subjects: Anticoagulants - therapeutic use; Dosage; Humans; Malignancy; Medicine; Medicine & Public Health; Mesothelioma; Mesothelioma - complications; Mesothelioma, Malignant; Oncology; Peritoneal Surface Malignancy; Peritoneum; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Pulmonary Embolism - etiology; Retrospective Studies; Risk Factors; Surgery; Surgical Oncology; Survival; Thromboembolism; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control; Pulmonary embolism; Deep vein thrombosis; Mesothelioma; Mesothelioma, malignant; Venous thromboembolism
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-024-15030-4

Introduction Venous thromboembolism (VTE) is a common complication in patients with abdominal malignancies. Despite known associations between pleural mesothelioma and increased VTE risk, the characteristics of VTE in patients with peritoneal mesothelioma (PeM) remain undescribed. Methods Patients treated for PeM were retrospectively identified from our institutional database. The frequency of VTE was assessed and logistic regression modeling was employed to assess VTE risk factors. The association between VTE and overall survival was also ascertained. Recommended thromboprophylaxis for patients who underwent surgery at our institution comprised a single preoperative dose of prophylactic anticoagulation, followed by daily dosing for four weeks postoperatively. Results Among 120 PeM patients, 26 (21.7%) experienced VTE, including 19/91 (20.9%) surgical patients, 4/23 (17.4%) patients who received systemic therapy, and 3/6 (50%) patients who underwent observation ( p  = 0.21). Most events were symptomatic ( n  = 16, 62%) and were attributable to pulmonary emboli ( n  = 16, 62%). The 90-day postoperative VTE rate was 4.4% (4/91), including 1 of 60 patients who underwent index surgical intervention at our institution and 3 patients with surgery elsewhere. A low serum albumin concentration was associated with VTE in non-surgical patients (odds ratio 0.12, confidence interval [CI] 0.02–0.72; p  = 0.03). No significant difference in overall survival was observed between patients with and without VTE (median 46.0 months [CI 24.9–67.0] vs. 55.0 months [CI 27.5–82.5]; hazard ratio 0.98 [CI 0.54-1.81], p  = 0.98). Conclusions A high risk of VTE was observed in PeM patients, warranting suspicion throughout the disease trajectory. Postoperative VTE rates were within acceptable limits with 4-week thromboprophylaxis.