Preoperative prevalence and risk factors of venous thromboembolism in patients with breast cancer: A retrospective cohort analysis

Background Although venous thromboembolism (VTE) is a serious perioperative complication in cancer patients, its preoperative prevalence and predictors in breast cancer (BC) remain insufficiently defined. With the increasing incidence of BC worldwide and the aging population in Japan, elderly patients with BC represent a growing subgroup at risk of VTE. Patients and Methods: We retrospectively analyzed the cases of 313 consecutive patients with BC who underwent breast surgery and preoperative evaluation at our institution. Clinical characteristics including age, comorbidities, and D-dimer level were collected. All of the patentis underwent imaging for the identification of VTE. We performed univariable and multivariable logistic regression analyses to identify predictors of VTE. Results Preoperative VTE was detected in 22 patients (7.0%). All cases were asymptomatic, and included pulmonary embolism (n = 1, 0.3%), proximal deep vein thrombosis (n = 2, 0.6%), and distal thrombosis (n = 20, 6.4%). In the univariable analysis, age ≥ 70 years (p < 0.001) and D-dimer ≥ 1 µg/mL (p < 0.001) were significantly associated with VTE, and hypertension showed a marginal association. Age ≥ 70 years and D-dimer ≥ 1 µg/mL remained an independent predictor. Predicted probabilities were negligible in the patients < 70 years, ~ 8% in those ≥ 70 years with normal D-dimer, and ~ 26% in those ≥ 70 years with elevated D-dimer. No patient experienced postoperative progression of VTE or a new pulmonary embolism. Conclusions Preoperative VTE was not uncommon in this BC series, particularly among the elderly patients with older age and elevated D-dimer. The combination of age and D-dimer provided a simple and practical method for perioperative risk stratification. Targeted screening and management of high-risk patients may enhance surgical safety. Larger multicenter studies are warranted to validate this strategy.