Connect the Dots—June 2017
Obstet Gynecol 2017;129:979–85
Standard of care for women who undergo debulking for ovarian, fallopian tube, or primary peritoneal cancer includes prophylaxis for venous thromboembolism. Greco et al (see page 979) report the results of a retrospective cohort study of 112 women who received neoadjuvant chemotherapy for one of these tumors to examine the rate of and risk factors for venous thromboembolism at various time points in their treatment course. Overall, 30 of the 112 (26.8%) women developed venous thromboembolism. Importantly, 13 of these occurred during the neoadjuvant chemotherapy course.
Venous thromboembolism during neoadjuvant chemotherapy not only adds morbidity to the patient at the time of the event, but can complicate her perioperative treatment later. The study suggests an opportunity to decrease the risks of venous thromboembolism and its attendant morbidity and mortality. Because observational studies can demonstrate only associations, not causality, the authors call for a randomized controlled trial of prophylactic anticoagulation during both neoadjuvant and adjuvant chemotherapy in women with these tumors.