Prolonged-duration chemoprophylaxis (PDC) was associated with reduced venous thromboembolism (VTE) but increased risk for nonfatal bleeding events in patients with head and neck cancer (HNC). These findings from a retrospective cohort study were published in JAMA Otolaryngology-Head and Neck Surgery.

For this study, 247 patients who underwent surgery lasting 2 or more hours for HNC with a Caprini risk score of 8 or higher at a single center between 2014 and 2020 were retrospectively reviewed for clinical outcomes. Patients were aged mean 63.1 years (standard deviation [SD], 11.1), 72.9% were men, and 57.1% received PDC.

Among patients receiving PDC, the mean duration of prophylaxis was 16.3 days (SD, 10.1); among those receiving traditional care, mean duration of prophylaxis was 2.8 days (SD, 1.7). These patients were more likely to have squamous cell carcinoma, have longer hospital stays, receive aspirin, and undergo a free flap reconstruction.

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VTE occurred in 6 patients (1/141 [0.7%] in PDC cohort; 5/106 [4.7%] in traditional care cohort), corresponding to a 7-fold reduction of VTE events among PDC recipients (odds ratio [OR], 0.15; 95% CI, 0.003-1.33). Correcting for free flap status indicated patients receiving PDC had a 28-fold reduction of VTE (OR, 0.04; 95% CI, 0.001-0.46).

Bleeding complications were observed in 7 patients (6/141 [4.3%] in PDC cohort; 1/106 [0.9%] in traditional care cohort), corresponding with an increased risk among PDC recipients (OR, 4.64; 95% CI, 0.55-217.00).

This study may have been biased by limiting the study period to 30 days, as risk for VTE may be sustained for up to 12 weeks.

The study authors concluded PDC therapy among patients undergoing surgery for HNC decreased risk for VTE, but with a nonnegligible increased risk for bleeding events.


Tipirneni KE, Bauter L, Arnold MA, et al. Association of prolonged-duration chemoprophylaxis with venous thromboembolism in high-risk patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. Published online January 14, 2021. doi:10.1001/jamaoto.2020.5151