Preventing thrombohemorrhagic complications during chemotherapy in patients with ovarian cancer

Objective. To evaluate the impact of different anticoagulant prophylaxis regimens on the state of the haemostasis system and the frequency of thrombohemorrhagic complications in patients with stage II–IV ovarian cancer undergoing chemotherapy.

Materials and methods. A prospective, comparative, randomised, interventional cohort study was conducted, including 313 women with histologically confirmed ovarian cancer in stages II–IV. The patients were randomised into three groups: I (n=104) who received prophylactic doses of low-molecular-weight heparins (LMWH); II (n=104) who received direct oral anticoagulants (DOAC) and III (n=105) – the control group without anticoagulant prophylaxis. All patients received standard chemotherapy as required. The state of haemostasis was evaluated using a set of laboratory parameters, including fibrinogen levels, D-dimer, thrombin-antithrombin complexes, prothrombin F1+2 and platelet aggregation. The patients were classified into four diagnostic categories according to the degree of disturbance to the haemostatic system: patients without signs of disseminated intravascular coagulation (DIC); compensated DIC with hyperfunction of platelets; subcompensated DIC with pronounced hypercoagulability; decompensated DIC with consumption thrombocytopathy.

Results. Before the start of chemotherapy, the frequency of normocoagulation was comparable in all groups (21–23%), with compensated and subcompensated forms of DIC predominant and no decompensated forms identified. During chemotherapy without anticoagulant prophylaxis, the proportion of normocoagulation decreased to 1,9%, while the proportion of subcompensated and decompensated DIC increased to 48,6 and 34,3%, respectively. In groups I and II, normocoagulation was maintained in 16,3–17,3% of patients, with compensated forms predominating and the frequency of decompensated DIC not exceeding 14,4%. The frequency of deep vein thrombosis and pulmonary embolism in the control group was 16,2 and 7,6%, respectively, whereas in group I it was 9,6 and 2,9%, respectively, and in group II it was 7,7 and 1,9%, respectively. Moderate bleeding was less common in the prophylaxis groups (4,8–6,7%) than in the control group (18,1%). There were statistically significant differences between groups with and without anticoagulant therapy (p<0,05), and non-significant differences between groups with LMWH and DOAC.

Conclusion. Chemotherapy for ovarian cancer patients causes significant haemostatic disturbances, accompanied by an increased risk of thrombotic complications. The application of anticoagulant prophylaxis in the form of both LMWH and DOAC significantly reduces the risk of thrombotic events and the severity of haemostatic disturbances while maintaining an acceptable rate of haemorrhages. Both regimens have comparable efficacy and safety, which justifies their use in clinical practice.