Assessment of Thromboprophylaxis Eligibility in Patients With Cancer at a Community Hospital

Presenting Authors: Christopher Clayton, PharmD, BCOP, and Sol Atienza, PharmD, BCOP, Aurora St. Luke’s Medical Center, Milwaukee, WI

BACKGROUND: Cancer is a risk factor for venous thromboembolism (VTE). VTE is a major cause of morbidity and mortality, which can lead to hospitalizations, substantial patient care needs, and increased cost for patients with cancer. The incidence of VTE within 1 year of a cancer diagnosis is approximately 8%.¹ Various risk-scoring tools have been evaluated to assess VTE risk based on clinical and laboratory factors. The current guidelines recommend the Khorana scoring tool to determine which patients with cancer are candidates for primary VTE prophylaxis.²

OBJECTIVES: To conduct a gap analysis to assess patients diagnosed with VTE and to determine which of those patients were eligible for VTE prophylaxis using the Khorana scoring tool.

METHODS: This retrospective chart review was conducted at a 900-bed community hospital between August 1, 2024, and September 1, 2025. The inclusion criteria were patients with cancer with a discharge diagnosis of deep vein thrombosis or pulmonary embolism who were actively receiving chemotherapy or immunotherapy. The exclusion criteria were patients with multiple myeloma, acute leukemia, myeloproliferative neoplasm, primary or metastatic brain tumor, carcinoma in situ, history of or risk for bleeding, having a cancer diagnosis during the current admission, and no chemotherapy or immunotherapy within the past 6 months. The data collection included malignancy, prechemotherapy platelet and leukocyte count, hemoglobin or red blood cell growth factor use, body mass index, anticoagulant medications, and the date of chemotherapy. The patients were evaluated using the Khorana score and were categorized as having a high risk for VTE when scores were ≥2.

RESULTS: A total of 93 patients were identified as diagnosed with cancer and VTE through diagnosis-related group codes on discharge. In all, 33 patients were excluded. Of the 60 patients assessed, 20 (33.3%) had Khorana scores of ≥2, showing eligibility for VTE prophylaxis. None of these patients were receiving VTE prophylaxis. A total of 7 patients were receiving anticoagulation for other reasons (eg, atrial fibrillation, previous VTE). Of the 20 patients, the cancer types were pancreas/lung (each 20%), gynecologic/bladder (each 10%), lymphoma/testicular (each 5%), and other (breast, head and neck, anal, chronic lymphocytic leukemia, colon, 30%). As per the Khorana score criteria, 20% of the cancers were very high risk and 50% were high risk, and the platelet, hemoglobin, leukocyte, and body mass index parameters were met in 25%, 55%, 30%, and 45% of patients, respectively.

CONCLUSION: The results confirm that primary VTE prophylaxis is underutilized. These data will be used as a baseline measurement to justify an electronic platform that identifies patients with cancer who are eligible for VTE prophylaxis in the clinical setting.

1. Mahajan A, Brunson A, White R, Wun T. The epidemiology of cancer-associated venous thromboembolism: an update. Semin Thromb Hemost. 2019;45:321-325.
2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: cancer-associated venous thromboembolic disease. Version 3.2025. November 6, 2025. Accessed December 18, 2025. www.nccn.org/professionals/physician_gls/pdf/vte.pdf
3. Ay C, Pabinger I, Cohen AT. Cancer-associated venous thromboembolism: burden, mechanisms, and management. Thromb Haemost. 2017;117:219-230.
4. Carrier M, Abou-Nassar K, Mallick R, et al. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med. 2019;380:711-719.
5. Khorana AA, Kuderer NM, Culakova E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111:4902-4907.
6. Khorana AA, Mackman N, Falanga A, et al. Cancer-associated venous thromboembolism. Nat Rev Dis Primers. 2022;8:11.
7. Khorana AA, Otten HM, Zwicker JI, et al. Prevention of venous thromboembolism in cancer outpatients: guidance from the SSC of the ISTH. J Thromb Haemost. 2014;12:1928-1931.
8. Li A, May SB, La J, et al. Venous thromboembolism risk in cancer patients receiving first-line immune checkpoint inhibitor versus chemotherapy. Am J Hematol. 2023;98:1214-1222.