Almost half of the cancer patients in a recent study did not receive any thromboprophylaxis during hospitalization, even though cancer and its treatment increases the risk for deep-vein thrombosis (DVT) and pulmonary embolism (PE) and three professional organizations—the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network—have issued guidelines recommending DVT prophylaxis.
“Cancer is a high-risk disease state for venous thromboembolism, because it causes hypercoagability and other biochemical changes,” said Alpesh N. Amin, MD, MBA, professor and chairman of the Department of Medicine and the executive director of the hospitalist program at the University of California, Irvine. “Yet only about half of the patients are getting prophylaxis. That’s a gap. In the hospital, a controlled setting, that gap needs awareness and process improvement from a quality/safety perspective.”
Amin and colleagues conducted a real-world analysis of nonsurgical cancer patients’ experiences with DVT and thromboprophylaxis, using the US Premier Perspective–i3 Pharma Informatics linked database for nonsurgical cancer patients who were admitted to the hospital from January 2005 to November 2007. They found 48.1% of the 3759 patients studied did not receive any thromboprophylaxis during hospitalization and only 2.9% of patients received pharmacologic prophylaxis in the 14 days after discharge. Amin reported on the findings at the 52nd American Society of Hematology annual meeting and exposition.
During the index hospitalization among those receiving prophylaxis, 35% of patients received mechanical prophylaxis other than graduated compression stockings, 12.5% were given compression stockings, 13.8% unfractionated heparin, 8.4% enoxaparin, and 17.4% received a combination of measures.
Symptomatic DVT/PE events occurred in 2.4% of the patients during their index hospitalization: 2.8% had a DVT and 1.2% a PE event. During the 30 days following discharge, 1.3% of the patients were readmitted with a DVT/PE and an additional 0.3% were treated in the outpatient setting.
About 300,000 patients die each year from PE and estimates are that half are preventable, because good therapies are available, Amin said. Patients can experience recurrent DVTs and repeat hospitalizations to deal with them. After discharge, patients also may need DVT prophylaxis at home. Amin said additional research is needed to determine the appropriate prophylaxis and duration after release from the hospital.
Speculating about why prophylaxis rates are not higher, Amin indicated that physicians often fear bleeding, which requires an assessment and finding the balance, and other providers lack awareness of the risk and require education.