No Increased Risk for Venous Thromboembolism in Keratinocyte Carcinoma

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Given the inherent risks associated with chemoprophylaxis, the need for prophylactic anticoagulation in patients with KC undergoing surgery should be considered.
Given the inherent risks associated with chemoprophylaxis, the need for prophylactic anticoagulation in patients with KC undergoing surgery should be considered.

No increased risk for venous thromboembolism (VTE) has been demonstrated among patients with keratinocyte carcinoma (KC), although the need for prophylactic anticoagulation among patients with the condition who are scheduled for surgery should be carefully considered, according to the results of a population-based retrospective analysis published in JAMA Facial Plastic Surgery.

The investigators sought to determine the risk for VTE among patients with KC compared with that among individuals not diagnosed with cancer and among individuals with common malignant neoplasms associated with VTE. Patients were divided into 1 of 3 cohorts: patients with KC; patients with pancreatic cancer or acute myelogenous leukemia who are therefore at high risk for VTE (high-risk group); and patients without a history of common malignant neoplasms (control group). Those patients with a history of another type of cancer were excluded from the KC cohort. Data collected were analyzed between April 1, 2007 and January 15, 2018.

The primary study outcome was risk for VTE within 1 year after a patient's index date, which was defined as the date of initial cancer diagnosis. For the control cohort, the index date was defined as the date after 365 days of continuous insurance enrollment. The final study sample comprised a total of 740,246 patients across the 3 cohorts. Patients were stratified as follows: KC cohort: n=417,839, of whom 53.6% were men; mean age, 64.2±13.6 years; high-risk cohort: n=7671, of whom 45.7% were men; mean age, 59.4±14.4 years; and control cohort: n=314,736, or whom 43.0% were men; mean age, 42.9±15.2 years.

The risk for VTE in the KC cohort was lower than that in the control cohort in univariable analysis (odds ratio [OR] 0.22; 95% CI, 0.20-0.23; P <.001); multivariable analysis (OR 0.29; 95% CI, 0.26-0.32; P <.001); and after matching across patient characteristics and known risk factors (OR 0.52; 95% CI, 0.35-0.78; P =.001).

Moreover, the risk for VTE in the KC arm was higher in the univariable analysis (OR 2.31; 95% CI, 2.23-2.41; P <.001); lower in the multivariable analysis (OR 0.85; 95% CI, 0.80-0.90; P <.001), and did not differ after the matching of patient characteristics and risk factors (OR 0.95; 95% CI, 0.89-1.01; P =.08) compared with that in the control arm.

The investigators concluded that the study results did not offer any evidence to support an increased risk for VTE in the KC cohort compared with the control cohort. They noted that given the inherent risks associated with chemoprophylaxis, the need for prophylactic anticoagulation among patients with KC who will be undergoing surgery requires careful consideration, as inappropriate use of these agents can lead to perioperative complications.

Reference

Rudy SF, Li K, Moubayed SP, Most SP. Risk of venous thromboembolism in patients with keratinocyte carcinoma [published online May 24, 2018]. JAMA Facial Plast Surg. doi:  10.1001/jamafacial.2018.0331

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