Incidence of Venous Thromboembolic Events with Long Term Enoxaparin in Patients Undergoing Robotic Surgery for Endometrial Cancer

Study Objective To determine the incidence of venous thromboembolic (VTE) events in patients undergoing robotic surgery for endometrial cancer who receive postoperative enoxaparin for 28 days starting before surgery versus those receiving only a single dose of preoperative prophylaxis with enoxaparin. Design Retrospective cohort study. Setting University hospital. Patients or Participants All patients undergoing robotic assisted surgical staging between 1/2017 to 8/2020 for endometrial intraepithelial neoplasia (EIN), endometrial adenocarcinoma (EAC), uterine serous carcinoma (USC), and uterine carcinosarcoma (MMMT). Exclusion criteria included a history of a prior thromboembolic event prior to surgery (i.e., DVT, PE), thrombophilia, history of a prior CVA, or use of anti-coagulant therapy prior to surgery. Interventions N/A. Measurements and Main Results A total of 190 patients had robotic assisted surgical staging for endometrial cancer by two attending surgeons at a single gynecologic oncology practice during the study period. One hundred fifty-nine patients met inclusion criteria. In this cohort, 35 (22%) patients received 28-days of prophylactic enoxaparin postoperatively and 124 (78%) patients did not receive postoperative enoxaparin. There was no significant difference between the 2 groups with respect to age, BMI, tobacco use, aspirin use, and ASA classification. There was no significant difference between the 2 groups with respect to postoperative diagnosis, tumor grade, and stage. There was no significant difference between length of stay and postoperative complications. The rate of clinical VTE diagnosed within 30 days postoperatively was 0 (0%) in the group receiving 28-days of enoxaparin postoperative and 1 (0.81%) in the group receiving no prophylactic enoxaparin (p= 1.0). Conclusion In our patient population, no significant increase in rate of clinical VTE was observed in patients who did not receive 28-days of postoperative enoxaparin compared to those receiving one dose of preoperative enoxaparin who were undergoing robotic surgery for endometrial cancer.