Summary
Ovarian cancer cells appear to be capable of both thrombin formation and induction
of fibrin degradation which may be essential prerequisites for the development of
deep vein thrombosis (DVT) as well as the spread of malignancy. To study further this
coagulation – cancer interaction in 60 patients with untreated ovarian cancer of FIGO
stage I-IV the incidence of DVT was recorded pre-operatively, postoperatively on day
1, 3, 5, 7, 10, before each of six cycles of Cisplati- num/Epirubicin/Cyclophosphamide
chemotherapy, during follow-up and in the post-operative period of second look surgery.
In addition, blood coagulation tests results were determined prospectively. Two patients
were excluded from these calculations due to previous DVT 5 to 6 weeks before the
diagnosis of ovarian cancer but all patients were eligible for surgery and randomized
to receive either daily low molecular weight heparin (LMWH) (n = 28) or unfractionated
heparin (UFH) (n = 32) for perioperative thrombosis prophylaxis until the 7th postoperative
day. According to the FIGO stage, patients were equally distributed in the 2 heparin
treatment groups. The predictive value of pre-operative coagulation test results,
clinical parameters, and type of heparin used were tested in univariate and multivariate
analysis for development of post-operative DVT and overall patients survival. Impedance
plethysmography for DVT screening was used. The presence of DVT was then confirmed
by phlebography. Only D-dimer and fibrinogen levels were correlated significantly
with the FIGO stage while antithrombin, protein C, and plasminogen activator inhibitor
activity were not. The incidence of DVT was 6.7% (4/60) up to the 7th and 8.3% (5/60)
between the 8th and 29th post-operative day. DVT occurred in 10.6 % (5/47) during
chemotherapy. Pre-operative coagulation test results, the type of heparin used, and
clinical parameters were not significant risk factors for post-operative DVT development
in univariate analysis. The D-dimer and fibrinogen levels were significant risk factors
for reduced overall survival in univariate analysis but only the FIGO stage was an
independent predictor (in multivariate analysis). After a median follow up of 26.5
months (min. 8 months, max. 41 months), 21.4% of LMWH treated and 37.5% of UFH-treated
patients died of cancer (p = 0.26). Pre-operative test results were neither predictive
for DVT nor the outcome of cancer but patients showed an improved though not statistically
significant overall survival after LMWH treatment.
