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Inferior vena cava filter and aspirin in thromboprophylaxis during resection of pelvic malignancies

Background:Patients with pelvic malignancies at risk of postoperative hemorrhage often are not given antithrombolic chemoprophylaxis after large surgical resections, increasing the risk of a fatal pulmonary embolism (PE). The appropriate prophylactic strategy for these patients has been debated in an effort to balance the risks of hemorrhage and thromboembolism. Methods:We retrospectively examined the safety and efficacy of aspirin, pneumatic compression devices (PCD), and an inferior vena cava (IVC) filter postoperatively in preventing fatalities in these patients. Qualified patients with large pelvic resections who received aspirin, PCDs, and an IVC filter for thromboprophylaxis were followed for 6 mo postoperatively. The rates of deep vein thrombosis (DVT) and symptomatic or fatal PE were assessed. Results:Of 24 patients, two had a DVT and none incurred a symptomatic or fatal PE in 6 mo postoperatively. There were no significant correlations (P-values<0.05) between DVT or PE and patient age, sex, chemotherapy use, radiation therapy use, or surgery performed. Conclusions:In patients with large pelvic malignancies, the risk for mortality from PE is greatly increased. Risk may be reduced by inclusion of an IVC filter with aspirin and PCDs. Surgeons should consider this strategy during large pelvic resection for malignancy.