Archives d'oncologie chirurgicale

Multiple Anticoagulant Use Increases Wound Complications Following Resection of Lower Extremity Soft Tissue Sarcomas

Abstract

King DM, Bedi M, Hackbarth DA and Neilson JC

Objectives: Prevention of thromboembolic complications is a concern in patients who undergo resection of Soft Tissue Sarcomas (STS). The risk of thrombosis must be balanced with the increased risk of haemorrhage and wound healing complications in this difficult patient population. In this study we aim to determine if multiple anticoagulant use increases the risk of post-operative Major Wound Complications (MWC) in STS of the lower extremity.
Material and methods: Between 2000-2015, 134 patients with localized STS of the lower extremity underwent limb-salvage surgery. Patient and treatment variables, including anticoagulant use, wound outcomes, and thrombotic events were reviewed. Predictors for MWC were evaluated using the fisher exact test for Univariate (UVA) and logistic regression for Multivariate Analysis (MVA).
Results: The overall MWC rate in this patient population with lower extremity and buttock tumours was 35%. The MWC rate in patients on ≥2 anticoagulants were 60% versus 24% in patients taking <2 anticoagulants (p<0.001). Patients on warfarin had a higher MWC rate, 61%, versus those not taking warfarin, 28% (p=0.004). On MVA, warfarin use (p=0.02, OR 3.6) On MVA, ≥2 anticoagulants (p<0.001, OR 4.3) and warfarin use (p=0.02, OR 3.6) were found to have an increased propensity for MWCs.
Conclusion: Patients administered, ≥2 anticoagulants and warfarin use was associated a higher risk of post-operative MWCs. Anticoagulants used for DVT prophylaxis were not associated with an increased risk of MWC alone, but only when combined with other anti-coagulants.