MANAGEMENT OF GYNECOLOGIC ONCOLOGY PATIENTS WITH A PREOPERATIVE DEEP-VEIN THROMBOSIS

Our experience with gynecologic oncology patients presenting preoperat ively with a deep vein femoral thrombosis is reported. Over a 3-year p eriod data were collected on all patients at the University of South F lorida (USF) requiring surgery for a known or suspected gynecologic ca ncer and having a concomitant active femoral venous thrombosis. Twelve such patients were managed. Management was divided among three option s: heparinization, preoperative inferior vena cava (IVC) filter, and i ntraoperative IVC ligation. For two patients a filter could not be pla ced preoperatively due to tumor compression of the IVC. Both underwent IVC ligation intraoperatively. One of the two died intraoperatively, possibly related to pulmonary embolism. One of eight with a preoperati ve IVC filter had obvious clot propagation postoperatively, managed wi th heparin. One of two managed with heparin only had severe bleeding a nd heparin associated thrombocytopenia (HAT) preoperatively. Based on our experience and a review of the literature, we recommend therapeuti c heparinization and ii preoperatively placed IVC filter for most preo perative gynecologic oncology patients with femoral deep venous thromb osis. (C) 1997 Academic Press