Effect of prophylactic anticoagulation on the incidence of venous thromboembolism in patients with testicular germ cell tumor.

Abstract

Background Testicular germ cell tumors (GCTs) are among the most common solid tumors in young males. With the availability of highly effective treatment, improving patients’ quality of life has gained more focus in recent years. Venous thromboembolism (VTE), commonly occurring in patients with GCT, is associated with increased morbidity and mortality. Prophylactic anticoagulation has been shown to decrease the risk of VTE in patients with malignancy. The aim of this retrospective study was to evaluate the effect of low-molecular-weight heparin (LMWH) prophylaxis on the incidence of VTE and outcome in patients with GCT treated with first-line chemotherapy. Methods Our study population included chemotherapy-naive patients with GCT treated with first-line chemotherapy at the National Cancer Institute, Bratislava, Slovakia, from January 2000 to December 2017. VTE was defined as any venous thrombosis or pulmonary embolism, confirmed by imaging, occurring during first-line chemotherapy. Patients diagnosed with VTE on initial staging exam were excluded from the study. No visceral thromboses were observed. Results Our cohort included 353 patients with GCT. LMWH prophylaxis was administered to 104 patients (29.5%), and 249 patients (70.5%) did not receive prophylaxis. We observed 14 (4.0%) VTE events. The difference in VTE incidence between patients with and without prophylaxis was not statistically significant (5.8% vs. 3.2% P = 0.37). We observed a trend toward longer overall survival in patients without prophylaxis (hazard ratio = 0.61, 95% confidence interval = 0.32-1.13, p = 0.08). Patients with extragonadal GCT receiving VTE prophylaxis had significantly shorter survival (hazard ratio = 0.29, 95% confidence interval = 0.08-1.12, P = 0.04). This effect was most likely driven by a higher incidence of treatment-related deaths in patients with extragonadal GCT receiving LMWH ( P = 0.06). Conclusions LMWH prophylaxis was not associated with decreased VTE incidence.Moreover, there was a higher incidence of treatment-related deaths in patients with extragonadal tumor location. LMWH prophylaxis during hospitalization should not be used routinely in patients with GCT receiving chemotherapy.