ABS ePoster Library

P050
Topic: Breast surgery

Introduction: Patients at high risk for thromboembolism undergoing breast surgery require multidisciplinary management of their anticoagulation to carefully balance the risk of thromboembolism and bleeding. However, there is a lack of published guidelines on the perioperative management of anticoagulation specific to the wide range of breast surgery operations and insufficient evidence to justify the application of guidelines developed for other specialties. Methods :A literature search was performed, reviewing evidence regarding venous thromboembolic events in breast surgery and perioperative risk assessment and management of anticoagulated patients at high risk for thromboembolism. Data regarding post-operative haematomas was also reviewed. Literature was presented in a multidisciplinary forum and a consensus pathway developed in conjunction with cardiologists, haematologists and surgeons. Results:In patients deemed to be low risk for thromboembolic events, the risk in breast cancer surgery is low. However, the high-risk group require individual assessment. A balance of risks between thromboembolism and bleeding is essential. Thromboembolism in this group has potential severe sequelae. Our local pathway includes a risk assessment model to stratify those patients who require bridging anticoagulation with heparin. In particular we review the assessment of patients with atrial fibrillation, coronary stents, and mechanical heart valves. Conclusion:There is a need for a structured pathway for the multidisciplinary management of high-risk patients. Risk stratification is paramount in ensuring safe patient care. National guidelines are needed to ensure that these patients receive the appropriate cancer treatment whilst their risk of thromboembolism and bleeding is managed safely and appropriately.