Prospective Evaluation of Coagulation Changes after Combined Ablative and Reconstructive Breast Surgery

Purpose: Patients undergoing combined tumor resection and reconstructive surgery for breast cancer are at high-risk for venous thromboembolism (VTE) yet specific coagulation changes remain unknown in this population. We assess the global hemostatic function of this cohort via rotational thrombo-elastography (ROTEM) in the perioperative period.

Methods and Materials: A prospective study of patients undergoing immediate reconstruction following mastectomy for treatment of breast neoplasm was conducted. Prior to acceptance into study, informed consent was obtained. ROTEM was performed on blood samples taken pre-operatively, on post-operative day 1, and at 1 week follow-up.  Clotting time (CT), α-angle (clot kinetics), clot formation time (CFT), maximum clot formation (MCF), and hypercoagulability was determined at each time point. Data are expressed as MąSD or median(IQR) and compared using a Friedman or Cohrane's Q test, as appropriate. Significance was determined at p≤0.05.

Results:  37 female patients with age of 54ą10 years were included. 31 underwent implant-based reconstruction, 4 autologous reconstructions with free tissue transfer, and 2 oncoplastic reconstruction.  The table below shows changes in the coagulation parameters over the peri-operative period.

Longitudinal Coagulation Changes (n=37)
	Pre-op	Post-op	Week-1	p value
CT, sec	58(15)	59(9)	59(17)	0.641
α-angle, °	75(7)	75(5)	79(2)	0.261
CFT, sec	77(30)	79(28)	59(9)	0.053
MCF, mm	64(8)	64(6)	73(13)	0.040
Overall Hypercoagulable	19%	11%	62%	0.042

Conclusions:  Patients undergoing combined tumor resection and reconstructive surgery for breast cancer become more hypercoagulable in the perioperative period. The significant contributor to hypercoagulability is MCF, representing platelet function. Anti-platelet therapy may play a role in thromboprophylaxis in this population.