OC 66.5 - Antithrombotic prophylaxis following inferior vena cava replacement with cryopreserved aortic homograft for primary leiomyosarcoma: a cohort study

Tuesday, June 25, 2024

15:45 – 16:00 ICT

Room: 111 A-C

Presenting Author(s)

Juri Alessandro Giannotta, Medical Doctor

MD
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
Milano, Lombardia, Italy

Co-Author(s)

MC

Marco Capecchi

MD
Division of Hematology, Gruppo Ospedaliero Moncucco - Clinica Moncucco, Lugano, Switzerland
Lugano, Ticino, Switzerland
SR

Stefano Radaelli

MD
Sarcoma Service, Surgical Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
Milano, Lombardia, Italy
LB

Laura Benuzzi

MD
General Surgery Residency Program, University of Milan, Milan, Italy
Milano, Lombardia, Italy
FD

Federica Del Coco

MD
General Surgery Residency Program, University of Milan, Milan, Italy
Milano, Lombardia, Italy
AG

Alessandro Gronchi

MD
Sarcoma Service, Surgical Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
Milano, Lombardia, Italy
MF

Marco Fiore

MD
Sarcoma Service, Surgical Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
Milano, Lombardia, Italy
Paolo Bucciarelli

MD
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
Milano, Lombardia, Italy

Background: Primary leiomyosarcoma of the inferior vena cava (IVC) is an ultra-rare tumor managed with multimodal treatment strategy including full-thickness surgical resection of IVC, although consensus is lacking regarding the best conduit for reconstruction. Aortic homograft may show better resistance to infections and extrinsic compression, but the antithrombotic strategy to prevent occlusion is not evidence-based.

Aims: To evaluate efficacy and safety of an antithrombotic protocol (weight-adjusted low molecular weight heparin shifted to antiplatelet therapy after 3 months) for IVC replacement with cryopreserved aortic homograft.

Methods: Consecutive patients undergoing surgery for primary leiomyosarcoma of the IVC at a referral tertiary sarcoma center were enrolled from September 2020 to June 2023. Figure 1 details the study timepoints and the antithrombotic protocol. Primary outcomes were the prevalence of graft patency during follow-up and the rate of bleeding events during antithrombotic treatment (graded according to the ISTH guidelines). The study was approved by Comitato Etico Territoriale Lombardia 4.

Results: Eighteen patients (Table 1) were enrolled. Graft was patent in 16/18 patients (89%, 1-year follow-up available in 14/18 patients), although 3/16 patients received 3-month full-dose oral anticoagulation instead of per protocol prophylaxis due to post-surgery, not graft-related venous thrombosis. Graft occlusion occurred in two patients at day +7 and month +3, respectively, and was managed with direct oral anticoagulants, without recanalization. Both were middle-aged females, with a history of rheumatic disease (undifferentiated connective tissue disease and seronegative arthritis), and one cardiovascular risk factor each (obesity and family history of cardiovascular disease). Bleeding was registered in 2 patients (11%): one major event during enoxaparin prophylaxis at day +10 from IVC surgery, and one minor (bruising) during prolonged treatment with acetylsalicylic acid.

Conclusion(s): Although more prospective data are needed, 3-month anticoagulant prophylaxis, followed by antiplatelet therapy, can be considered to prevent aortic homograft occlusion after IVC replacement for primary leiomyosarcoma.