Abstract
Background
Postoperative venous thromboembolism (VTE) is a common and life-threatening complication in ovarian cancer surgery, which not only prolongs the patient’s hospital stay but also increases the risk of postoperative death. Based on this, this study aims to explore the factors affecting the incidence of postoperative VTE in ovarian cancer patients, so as to provide a reference for clinical risk assessment and targeted prophylactic measures.
Methods
A retrospective study was conducted involving 67 patients with ovarian cancer who developed postoperative VTE at our hospital. The period we considered for our study was between August 2020 and August 2022. We also looked at 100 patients who did not experience postoperative VTE, which was confirmed by imaging during the same period. To comprehensively capture the occurrence of postoperative VTE, all 167 enrolled patients underwent systematic imaging examinations within 1 month after surgery - abdominal and lower extremity vascular ultrasound was performed for all patients at 1 week and 3 weeks postoperatively, and contrast-enhanced computed tomography (CTA) was further conducted for patients with suspicious ultrasound findings. No imaging examination was limited to only symptomatic patients; this systematic screening method ensured no missed diagnosis of asymptomatic VTE cases. Clinical data from both groups were analyzed and compared to identify risk factors associated with postoperative VTE in patients with ovarian cancer. We observed the time when the blood clot appeared, which was one month after the operation.
Results
The univariate analysis revealed statistically significant differences between the two groups with respect to age, hypertension, menopausal status, neoadjuvant chemotherapy, FIGO tumor stage, lymph node metastasis, operation duration, and preoperative plasma levels of fibrinogen (FIB) and D-dimer (all P < 0.05). Multivariate analysis identified advanced age, neoadjuvant chemotherapy, advanced FIGO stage, and elevated preoperative plasma levels of FIB and D-dimer as independent risk factors for postoperative VTE in patients with ovarian cancer (all P < 0.05).
Conclusion
Advanced age, neoadjuvant chemotherapy, advanced FIGO tumor stage, and elevated preoperative levels of plasma FIB and D-dimer are significant risk factors for postoperative VTE in patients with ovarian cancer. Enhanced perioperative clinical management of patients identified as high risk is recommended to mitigate the incidence of postoperative VTE in this population.
Keywords: Ovarian cancer, Postoperative VTE, Risk factors, Coagulation markers, Venous thromboembolism
Background
Venous thromboembolism (VTE) is a prevalent complication among patients with malignant tumors and ranks as the second leading cause of mortality after the malignancy itself [1]. VTE can manifest as deep vein thrombosis or pulmonary embolism, depending on the location and stage of disease progression. In the treatment of gynecologic malignancies, VTE represents a significant complication. Although the underlying mechanisms of VTE in gynecologic malignancies are comparable, the incidence rates and associated risk factors vary among different pathological types of these tumors [2, 3] Among all ovarian cancer subtypes, clear cell carcinoma has the strongest correlation with VTE, with its postoperative VTE incidence (18.3%−21.7%, as reported in the above reviews) being significantly higher than that of serous carcinoma (7.5%−9.8%) and mucinous carcinoma (5.1%−6.4%) [4, 5].
Ovarian cancer is a gynecological malignancy with a high incidence of VTE. VTE can reduce patient survival time, increase short-term mortality, and impose a significant economic burden on patients and their families [6]. Therefore, it is crucial to accurately identify the risk factors for VTE and implement timely preventive and therapeutic measures to enhance the prognosis of patients with ovarian cancer [7].
Although current studies have confirmed that VTE is a major complication of ovarian cancer, there are still uncertainties to be addressed: (1) The specific mechanism by which neoadjuvant chemotherapy affects the risk of postoperative VTE remains controversial, with inconsistent conclusions on whether it increases or reduces the risk; (2) The predictive threshold of fibrinogen and D-dimer in the perioperative period for postoperative VTE has not been unified, and their clinical application value needs further verification. This study retrospectively examined factors associated with postoperative VTE in patients with ovarian cancer, identified high-risk factors, and aimed to facilitate early identification and intervention. The findings are intended to serve as a clinical reference to improve the quality of life, prognosis, and to effectively reduce the incidence of thrombosis-related disability and mortality in patients with ovarian cancer.
Materials and methods
General data
This study utilized the hospital’s medical record management system to identify patients diagnosed with ovarian cancer via postoperative pathology from August 2020 to August 2022. A total of 167 patients were identified. Among these, 67 patients developed VTE post-surgery. A control group of 100 patients with ovarian cancer who did not experience VTE was also selected from the same period. Data from both groups were collected and analyzed for comparative purposes.
Inclusion and exclusion criteria
VTE is the most common cause of deep vein thrombosis. Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) refer to abnormal clotting of blood in the venous system, resulting in partial or complete blockage of a blood vessel. It is a clinically common vascular disease with a potentially fatal risk. We determined the occurrence of postoperative VTE by DVT and CTPA.
Inclusion criteria: (1) Patients with ovarian cancer who received surgical treatment in our hospital; (2) Patients with complete clinical case data and no missing information; (3) Patients with a definitive histopathological diagnosis of ovarian cancer confirmed by the pathology department of our hospital; (4) Patients with a clear imaging diagnosis of VTE confirmed by the ultrasound or radiology department of our hospital within 1 month after surgery; (5) The patient and their family have signed the informed consent form, and the research protocol has been approved by the Medical Ethics Committee of our hospital; The postoperative follow-up duration is ≥ 1 month.
Exclusion criteria: (1) Patients currently undergoing treatment with anticoagulant or antiplatelet medications; (2) Patients with severe liver or kidney disease; (3) Patients with concomitant malignant tumors; (4) Patients with blood system disorders; (5) Patients who had laparoscopic surgery which converted to open surgery; (6) Patients with a history of VTE or who experienced VTE prior to surgery; (7) Patients with severe complications such as postoperative infection and massive hemorrhage; (8) Patients with cognitive impairment, communication disorders, or inability to cooperate with follow-up.
Methods
To comprehensively capture the occurrence of postoperative VTE, all 167 enrolled patients underwent systematic imaging examinations within 1 month after surgery—abdominal and lower extremity vascular ultrasound was performed for all patients at 1 week and 3 weeks postoperatively, and contrast-enhanced computed tomography (CTA) was further conducted for patients with suspicious ultrasound findings. No imaging examination was limited to only symptomatic patients; this systematic screening method ensured no missed diagnosis of asymptomatic VTE cases.
Clinical data for both patient groups were collected through the hospital’s case management system, which included the following parameters: (1) Baseline data: age, body mass index (BMI), menopausal status, presence of complications, receipt of neoadjuvant chemotherapy (such as paclitaxel combined with carboplatin, docetaxel combined with cisplatin, etc.), and Caprini score; (2) Preoperative laboratory results: hemoglobin (HGB), white blood cell count (WBC), platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen (FIB), D-dimer, CA125, and HE4 levels; (3) Surgical details: type and duration of surgery, intraoperative bleeding and blood transfusion, and postoperative thrombosis prevention measures (The preventive measures included wearing elastic socks to prevent deep vein of lower limb thrombosis, and subcutaneous injection of LMWH); (4) Tumor pathology: tumor diameter, grade, stage, histological type, and lymph node metastasis. Comparative analysis was conducted between the two groups based on these data.
For patients with normal liver and kidney function, low-molecular-weight heparin (LMWH) was chosen (e.g., enoxaparin sodium, 4000 IU subcutaneously once daily) due to its stable anticoagulant effect and low risk of bleeding; for patients with mild renal impairment, oral apixaban (2.5mg twice daily) was adopted, as it requires no dose adjustment in this population. for patients with no high-risk factors for VTE, the prophylactic anticoagulant therapy lasted for 7 days after surgery; for those with high-risk factors (e.g., BMI ≥ 30kg/m², operation duration > 3h), the duration was extended to 14 days.
Statistical analysis
All the data collected in this study were analyzed using SPSS 25.0 software, and Excel was utilized for the preliminary collection and organization of target data. Normally distributed measurement data were expressed as mean ± standard deviation (SD), while non-normally distributed measurement data were expressed as median (interquartil range), and the comparisons were examined by Student-t test and Mann-Whitney test (non parametric distribution). The categorical data were expressed as n(%), and the differences between the two groups were examined by chi-square analysis or Fisher’s exact test. Multivariate analysis was conducted using binary logistic regression, variables were included based on the results of univariate significance (P < 0.05) and clinical relevance. P<0.05 was considered statistically significant.
Results
Univariate analysis of clinical baseline data
Univariate analysis was conducted to evaluate the clinical baseline data of 67 patients with thrombus and 100 patients without thrombus. The median age was 58 years for the thrombus group and 52 years for the non-thrombus group. Hypertension was present in 49 patients (73.1%) in the thrombus group and 54 patients (54.0%) in the non-thrombus group. Neoadjuvant chemotherapy was administered to 26 patients (38.8%) in the thrombus group, compared to 19 patients (19.0%) in the non-thrombus group. Significant differences were observed between the two groups for these factors (P < 0.05). The median Caprini score was 4 (interquartile range: 2–5) in the VTE group and 3 (interquartile range: 2–4) in the non-VTE group, with no statistical difference between the two groups (P = 0.126). Additionally, no significant differences were found regarding BMI, diabetes, hyperlipidemia, or surgical history (P > 0.05), as shown in Table 1.
Table 1.
Comparison of clinical baseline data between the two groups [n(%)]
| Characteristics | Thrombus group (n = 67) | Nonthrombotic group (n = 100) | z/χ2 value | P value |
|---|---|---|---|---|
| Age [M(P25,P75),year] | 58.00 (52.00,69.00) | 52.00 (46.00,67.00) | −3.256 | 0.002 |
| BMI [M(P25,P75),kg/m2] | 20.60 (18.32,23.38) | 22.43 (19.65,24.32) | −1.123 | 0.325 |
| Menopausal state | 5.645 | 0.018 | ||
| No | 18 | 46 | ||
| Yes | 49 | 54 | ||
| Diabetes | 3.578 | 0.061 | ||
| No | 56 | 93 | ||
| Yes | 11 | 7 | ||
| Hypertension | 4.258 | 0.032 | ||
| No | 41 | 76 | ||
| Yes | 26 | 24 | ||
| Hyperlipemia | 1.124 | 0.326 | ||
| No | 55 | 88 | ||
| Yes | 12 | 12 | ||
| Operation history | 0.023 | 0.965 | ||
| No | 39 | 61 | ||
| Yes | 28 | 39 | ||
| Neoadjuvant chemotherapy | 6.324 | 0.015 | ||
| No | 41 | 81 | ||
| Yes | 26 | 19 | ||
| Caprini score | 5.897 | 0.074 | ||
| < 5 | 1 | 6 | ||
| 5–7 | 36 | 64 | ||
| 8–10 | 27 | 29 | ||
| ≥ 11 | 3 | 1 |
Univariate analysis of preoperative laboratory tests
Univariate analysis of preoperative laboratory data from 67 patients with thrombosis and 100 patients without thrombosis revealed statistically significant differences in FIB and D-dimer levels between the two groups (P < 0.05). However, no significant differences were observed in PLT count, WBC count, HGB, PT, APTT, CA125, and HE4 levels (P > 0.05), as shown in Table 2.
Table 2.
Comparison of preoperative laboratory test results between the two patient groups [M (P25,P75)]
| Characteristics | Thrombus group(n = 67) | Nonthrombotic group(n = 100) | z value | P value |
|---|---|---|---|---|
| PLT(×109/L) | 246(187,348) | 238(173–336) | −0.812 | 0.387 |
| WBC(×109/L) | 5.46(4.45,7.18) | 5.61(4.23,7.21) | −0.635 | 0.526 |
| HGB(g/L) | 119.00(106,137) | 122(112,141) | −1.896 | 0.062 |
| PT(s) | 11.5(10.60,12.62) | 11.40(10.70,11.89) | −1.196 | 0.205 |
| APTT(s) | 30.50(27.00,34.10) | 31.20(28.90,35.61) | −1.483 | 0.135 |
| FIB(g/L) | 4.25(3.18,4.96) | 3.36(3.08,4.67) | −2.765 | 0.003 |
| D-dimer(ug/mL) | 1.52(0.07,2.45) | 0.78(0.39,1.57) | −3.586 | 0.001 |
| CA125(U/mL) | 178.45(56.70,423.60) | 157.42(35.16,386.52) | −0.684 | 0.512 |
| HE4(pmol/L) | 156.43(95.46,345.60) | 136.23(75.41,317.89) | −1.764 | 0.071 |
Univariate analysis of surgical conditions
Single-factor analysis of 67 patients with thrombosis and 100 patients without thrombosis revealed a statistically significant difference in operation time between the two groups (158.6 ± 23.5 versus 122.3 ± 18.7 min, P < 0.05). However, no significant differences were found in intraoperative blood loss, surgical method, intraoperative or postoperative blood transfusion, or postoperative thrombosis prevention measures (P > 0.05), as shown in Table 3.
Table 3.
Comparison of surgical parameters between the two groups [n(%)]
| Characteristics | Thrombus group (n = 67) | Nonthrombotic group (n = 100) | z/χ2 value | P value |
|---|---|---|---|---|
| Time of operation (mean ± SD, ml) | 158.6 ± 23.5 | 122.3 ± 18.7 | −1.876 | 0.045 |
| Peroperative bleeding [M(P25,P75),ml] | 340 (200,500) | 350 (200,500) | 0.053 | 0.081 |
| Mode of operation | 1.358 | 0.226 | ||
| Laparoscope | 31 | 58 | ||
| Open surgery | 36 | 42 | ||
| Transfusion | 0.518 | 0.483 | ||
| No | 60 | 93 | ||
| Yes | 7 | 7 | ||
| Postoperative preventive measures | 0.614 | 0.718 | ||
| No | 15 | 20 | ||
| Mechanical/Pharmaceutical | 21 | 28 | ||
| Mechanical + Pharmaceutical | 31 | 52 | ||
Note: SD: standard deviation
Univariate analysis of postoperative tumor pathology
Univariate analysis of postoperative tumor pathology data from 67 patients with thrombosis and 100 patients without thrombosis indicated significant differences in FIGO stage and lymph node metastasis between the two groups (P < 0.05). There were 53 (79.10%) patients in thrombus group with III-IV FIGO staging, which was significantly more than those in Nonthrombotic group (55 patients 55.00%, P < 0.05). However, no significant differences were observed in tumor diameter, degree of differentiation, or histological type (P > 0.05), as shown in Table 4.
Table 4.
Comparison of postoperative tumor pathology between two groups [n (%)]
| Characteristics | Thrombus group (n = 67) | Nonthrombotic group (n = 100) | z/χ2 value | P value |
|---|---|---|---|---|
| Diameter of tumor[M(P25,P75),cm] | 9.87 (7.65,11.48) | 10.02 (7.48–11.64) | −0.125 | 0.798 |
| FIGO staging | 8.156 | 0.005 | ||
| Ⅰ+Ⅱ | 14 (20.90%) | 45 (45.00%) | ||
| Ⅲ+Ⅳ | 53 (79.10%) | 55 (55.00%) | ||
| Tissue typing | 0.168 | 0.625 | ||
| Serous | 48 (71.64%) | 77 (77.00%) | ||
| Non-serous | 19 (28.36%) | 23 (23.00%) | ||
| Differentiated degree | 2.563 | 0.228 | ||
| Low grade | 12 (17.91%) | 11 (11.00%) | ||
| Medium grade | 19 (28.36%) | 24 (24.00%) | ||
| High grade | 36 (53.73%) | 65 (65.00%) | ||
| Lymphatic metastasis | 4.512 | 0.028 | ||
| No | 35 (52.24%) | 69 (69.00%) | ||
| Yes | 32 (47.76%) | 31 (31.00%) | ||
Multivariate analysis of postoperative VTE in ovarian cancer
Based on the results of the univariate analysis, significant indicators were selected for logistic regression analysis. The findings indicated that advanced age, neoadjuvant chemotherapy, advanced FIGO stage, and elevated preoperative levels of plasma FIB and D-dimer were independent risk factors for postoperative VTE in patients with ovarian cancer (P < 0.05), as shown in Table 5.
Table 5.
Binary logistic regression analysis of postoperative venous thromboembolism in ovarian cancer
| Characteristics | SE | P | OR | 95%CI |
|---|---|---|---|---|
| Age | 0.018 | 0.029 | 1.048 | 1.002–1.125 |
| Menopausal state | 0.426 | 0.854 | 1.012 | 0.364–2.798 |
| Hypertension | 0.398 | 0.418 | 1.362 | 0.634–3.178 |
| Neoadjuvant chemotherapy | 0.405 | 0.032 | 2.498 | 1.187–5.462 |
| FIGO staging | 0.432 | 0.032 | 2.514 | 1.134–6.237 |
| Lymphatic metastasis | 0.387 | 0.796 | 1.176 | 0.453–2.563 |
| Time of operation | 0.004 | 0.124 | 1.213 | 0.967–1.009 |
| FIB (> 4.2g/L) | 0.148 | 0.017 | 1.365 | 1.114–2.257 |
| D-dimer (> 1.8mg/L FEU) | 0.176 | 0.005 | 1.687 | 1.175–2.538 |
Discussion
Tumors are significantly associated with venous thromboembolism (VTE). Previous studies have shown that the annual incidence of VTE in cancer patients is approximately 13.9%, much higher than the 3.0% in people without cancer. VTE has now become the second leading cause of death in cancer patients, and its occurrence is influenced by multiple factors [7, 8].
Cancer patients have systemic inflammatory responses; in addition, tumor compression of pelvic veins and prolonged bed rest can lead to secondary blood stasis [9]. Moreover, chemotherapy can induce a hypercoagulable state, while surgery causes secondary inflammation and limited limb mobility after operation, which further impairs blood return. Therefore, patients receiving such treatments have a significantly increased risk of VTE [9, 10].
Among these, patients with gynecological diseases have a higher incidence of postoperative VTE due to hormone therapy and the special nature of the surgical site; the risk is particularly prominent in ovarian cancer patients, which is related to older age, multiple complications from medications and surgery, late diagnosis, large tumor size, compression of the pelvic cavity by massive ascites, extensive surgical scope, and long treatment duration [11, 12] This study identified the key high-risk factors of VTE by analyzing the statistics of cases with postoperative VTE complicating ovarian cancer in our hospital.
Research indicates that early VTE may be associated with surgery and chemotherapy, while late-onset VTE is more frequently related to advanced age, late-stage disease, and incomplete surgical tumor resection [13]. A retrospective study examining preoperative VTE in 387 patients with primary ovarian cancer reported an incidence of VTE and pulmonary embolism (PE) at 13.4% and 9.3%, respectively. The study found that patients aged ≥ 58 years had a significantly higher risk of VTE compared to those aged < 58 years, suggesting that age is a significant factor in VTE occurrence [14]. This finding aligns with the results of the current study, likely due to reduced physical activity and impaired venous pump function in elderly patients. Additionally, increased levels of pro-coagulant factors such as factor VIII, factor VII, homocysteine, and plasma FIB with advancing age further elevate thrombosis risk [14, 15] Furthermore, univariate analysis in this study identified menopause as a contributing factor to VTE occurrence. Literature reports indicate that hysterectomy involving the removal of fallopian tubes and ovaries increases the risk of venous thrombosis by 16% compared to hysterectomy alone, suggesting that hormone levels may influence thrombosis risk, with lower hormone levels potentially contributing to VTE formation [15, 16] A large cohort study of patients with ovarian cancer also highlighted that the presence of two or more chronic comorbidities, such as diabetes and hypertension, was a major risk factor for VTE, in addition to cancer type and stage [16, 17] In present study, there were more patients with menopausal state, hypertension, and receiving neoadjuvant chemotherapy, which resulting in a higher VTE rate compared with previous studies. Therefore, elderly, obese, hypertensive, and diabetic patients are advised to increase physical activity, maintain a light diet, manage BMI, and regularly monitor blood pressure and blood sugar, with prompt intervention for any abnormalities [17]. Caprini score is a composite risk assessment tool that inherently integrates multiple variables already included in this study (e.g., age, body mass index [BMI], surgical duration, and presence of hypertension). If it were included in the multivariate logistic regression model, it would lead to multicollinearity (i.e., overlapping information between variables), which would distort the regression results and reduce the reliability of the identified independent risk factors. Therefore, after comprehensive consideration of statistical principles and model rationality, we did not include Caprini score in the multivariate analysis.
Tumor-induced activation of the coagulation system facilitates thrombus formation and is a significant factor contributing to the susceptibility of patients with cancer to VTE [18]. Occult thrombus often develops progressively during disease treatment and may remain undetected until pronounced clinical symptoms emerge, leading to a substantial proportion of VTE cases being overlooked. Research has indicated that markers such as platelets, hemoglobin, white blood cells, D-dimer, prothrombin fragment, and coagulation factor VIII can serve as predictors of VTE risk in patients with ovarian cancer [18, 19] This study observed that patients with thrombosis exhibited prolonged PT, which may be associated with the depletion of clotting factors and disruptions in coagulation pathways. D-dimer, a crucial indicator of coagulation, is frequently utilized in the diagnosis of thrombotic diseases and coagulation disorders. Elevated levels of D-dimer are particularly useful in screening for VTE, including occult cases [19, 20].
This study demonstrated that surgical duration significantly impacts venous thromboembolism (VTE) risk: operations lasting over 100 min were linked to increased risks of deep vein thrombosis (DVT) and pulmonary embolism (PE). Specifically, each additional 10 min beyond 100 min raised DVT risk by 7% and PE risk by 5% [21]. Consistent with existing literature [21]– [22], this study also found a statistically significant difference in surgical duration between the thrombus and non-thrombus groups, with longer duration correlating with higher VTE risk.
Ovarian cancer surgeries are often extensive, typically involving extensive lymph node dissection and resection of all suspected lesions. Such procedures cause severe tissue trauma, leading to coagulation factor III leakage, activation of the extrinsic coagulation pathway, and accelerated thrombosis [23]. Moreover, prolonged surgery, postoperative bed rest, and long-term limb immobilization impair muscle pump function, reduce blood flow velocity, and induce blood stasis. Intraoperative massive bleeding and subsequent blood transfusion may also increase blood viscosity, disrupt blood flow, and promote red blood cell aggregation [22–24]. However, no significant difference in transfusion rates was observed between the thrombus and non-thrombus groups in this study, potentially due to the small sample size. With the increasing use of minimally invasive techniques in gynecological oncology, there has been a trend towards favoring these methods over traditional open surgery. Research indicates that minimally invasive surgery may be associated with a lower risk of postoperative VTE compared to open surgery. This reduced risk is attributed to faster recovery, earlier mobilization, shorter hospital stays, and the avoidance of certain VTE risk factors [25–28]. However, this study did not find a significant difference in VTE rates between different surgical methods. Further large-scale, multi-center studies are required to definitively assess the impact of laparoscopic versus open surgery on venous thrombosis. Previous research suggests that tumor pathology can influence VTE risk [29, 30] Analysis of tumor pathology in this study revealed that a higher proportion of patients in the thrombus group had FIGO stage III or IV tumors compared to the non-thrombus group, with a statistical difference. Additionally, lymph node metastasis was more prevalent in the thrombus group, which also showed a significant difference.
Lymph node metastasis often signifies advanced tumor stage. Logistic regression analysis identified advanced FIGO stage as a significant risk factor for thrombosis, indicating that patients with late-stage ovarian cancer have a higher risk of postoperative VTE compared to those with early-stage disease. This finding aligns with existing literature, suggesting that tumor stage influences VTE occurrence, with later stages associated with higher incidence [30]. Possible explanations for this increased risk include external mechanical resistance due to tumor mass and ascites, which impedes lower limb blood flow and increases blood viscosity. Additionally, the tumor environment can elevate plasma procoagulant factors, significantly raising the risk of DVT. Clinicians should be vigilant in managing patients with advanced cancer to mitigate VTE risk [31, 32].
This study clarified the risk factors of postoperative VTE in ovarian cancer patients and the predictive value of FIB and D-dimer in Northwest China, while it also has certain shortcomings: it adopted a retrospective design, with data from electronic medical records (2020–2022) and missing partial clinical details; it is a single-center study, with enrolled subjects only from one tertiary hospital in Northwest China, which limits the extrapolation of results; in addition, the small sample size (167 cases) leads to insufficient statistical power, and potential confounding factors such as perioperative activity restriction are not included in the analysis, all of which may have a certain impact on the research conclusions.
Conclusion
The risk of VTE is influenced by multiple factors. Advanced age, neoadjuvant chemotherapy, advanced FIGO stage of the tumor, and elevated plasma FIB and D-dimer levels prior to surgery are associated with an increased risk of postoperative VTE. For patients identified as high risk, vigilant monitoring of these indicators can help mitigate the incidence of VTE. This approach enables clinicians to better assess the patient’s condition, make informed decisions, and implement appropriate intervention strategies.
Acknowledgements
We are particularly grateful to all the people who have given us help on our article.
Abbreviations
- VTE
Venous thromboembolism
- DVT
Deep venous thrombosis
- PE
Pulmonary embolism
- ERAS
Enhanced recovery after surgery
- OC
Ovarian cancer
- BMI
Body Mass Index
- FIB
Fibrinogen
Authors’ contributions
Conception and design of the research: Shi-Rui Jia; Acquisition of data: Shi-Rui Jia, Aziguli Yimamu; Analysis and interpretation of the data: Shi-Rui Jia, Aziguli Yimamu; Statistical analysis: Chao-Hong Deng, Jing Liu; Obtaining financing: Chao-Hong Deng, Jing Liu; Writing of the manuscript: Shi-Rui Jia, Aziguli Yimamu; Critical revision of the manuscript for intellectual content: Jing Liu, Jia-Shi Rui, Deng-Chao Hong, Aziguli Yimamu; All authors read and approved the final draft.
Funding
Analysis of High-Risk Factors for Venous Thromboembolism in Ovarian Cancer Patients under the VTE Prevention and Control System within the Hospital, Institutional Project, Project Number BY202310.
Data availability
All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.
Declarations
Ethics approval and consent to participate
The study was conducted in accordance with the Declaration of Helsinki (as was revised in 2013). The study was approved by Ethics Committee of the Affiliated Hospital of the Bazhou Peoples Hospital. Written informed consent was obtained from all participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Data Availability Statement
All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.