Adherence to Venous Thromboembolism Prophylaxis in High-Risk Gynecologic Cancer Patients during the Enhanced Recovery after Surgery Era

Abstract

Objectives: Venous thromboembolism (VTE) is a common complication in patients with gynecologic cancer, reducing survival and increasing the financial burden. This study aimed to assess the adherence to VTE prophylaxis and factors that influence physician decisions. Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Siriraj Hospital, Thailand.We included patients with gynecologic malignancies undergoing abdominopelvic surgery who were at high risk for VTE (Caprini score ≥ 5). Patient demographics, clinical profiles, and the adherence of the physician to the thromboprophylaxis protocols were evaluated. Results: From October 2023 to October 2024, 231 patients met the inclusion criteria. The median age was 59 years (interquartile range (IQR) 50–66) and the median body mass index was 24.4 kg/m² (IQR 21.1–28). Most patients (83.2%) had Caprini scores of 5 or 6. 219 (96.5%) patients received mechanical and/or pharmacological prophylaxis. However, only 50 patients (22%) received prophylaxis in accordance with the guidelines. The surgical route was the only factor significantly associated with guideline adherence. Conclusion: The adherence rate to VTE prophylaxis in perioperative gynecologic malignancy patients was low (22%). Further research is needed to understand barriers to adherence and the clinical consequences of noncompliance.