Background: Venous thromboembolism has been independently associated
with both malignant disease and orthopaedic surgery. Patients with bone or
soft-tissue tumors who undergo orthopaedic surgery may therefore be at high
risk for thromboembolic events. The purpose of the present retrospective study
was to determine the rate of clinically detected deep venous thrombosis and
pulmonary embolism in patients with trunk or extremity bone or soft-tissue
Methods: The medical records of patients with a confirmed diagnosis
of primary bone or soft-tissue sarcoma who had presented to our unit between
1998 and 2003 were reviewed with use of a standardized chart abstraction tool.
The data that were retrieved included patient-related data (demographic
characteristics, diagnoses, and surgical interventions), the use of adjuvant
chemotherapy or radiation therapy, additional risk factors for
thromboembolism, the use of thromboembolic prophylaxis, and confirmed
Results: Of the 252 patients who were identified, ninety-four had a
diagnosis of primary bone sarcoma and 158 had a diagnosis of primary
soft-tissue sarcoma. Approximately 70% of the cohort received
thromboprophylaxis, with 57% receiving low-molecular-weight heparin.
Thirty-seven patients were clinically suspected of having a deep venous
thrombosis. Nine patients had a deep venous thrombosis that was confirmed
radiographically, and in one case the diagnosis was made at another center,
resulting in a rate of clinically evident deep venous thrombosis of 4%. Nine
patients had a clinically suspected pulmonary embolism. One patient had
confirmation of the pulmonary embolism with use of a ventilation-perfusion
scan, one patient died of pulmonary embolism, and one patient had diagnosis of
the pulmonary embolism at another center, resulting in an overall rate of
pulmonary embolism of 1.2% and a rate of fatal pulmonary embolism of 0.4%. All
patients with thromboembolic events had a tumor involving the hip or thigh,
with the majority of the events occurring prior to definitive surgery.
Conclusions: The risk of a clinically apparent thromboembolic event
in patients with bone or soft-tissue sarcomas is comparable with that in other
orthopaedic patients. However, tumors in the hip or thigh may be associated
with a particularly high risk of thromboembolism. A prospective study is
needed to investigate factors that are predictive of thromboembolism and the
role of chemical thromboprophylaxis.
Level of Evidence: Prognostic Level IV. See Instructions
to Authors for a complete description of levels of evidence.