Frequent but Nontargeted Use of Pharmacologic Thromboprophylaxis in Hospitalized Patients With Cancer
Retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer, who are believed to be at high risk of venous thromboembolism. In a prospective cross-sectional study reported in Journal of Clinical Oncology, Zwicker et al found that although pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer, it is commonly used without regard to presence or absence of concomitant risk for venous thromboembolism.
Study Details
The study involved determination of prescription rates for thromboprophylaxis and factors influencing its use during hospitalization in hospitalized patients with cancer at five academic hospitals (Beth Israel Deaconess Medical Center, University of California at Davis, University of Rochester, Veterans Administration Medical Center/George Washington University, and Johns Hopkins Hospital).
Use of Thromboprophylaxis
Of the total of 775 patients enrolled, 247 (31.9%) had relative contraindications to pharmacologic prophylaxis. Among the 528 eligible for thromboprophylaxis, 377 (71.4%) were considered at high risk of venous thromboembolism by the Padua scoring system, and 297 (78.8%) of these patients received thromboprophylaxis. Among the 151 patients (28%) at low risk according to the Padua scoring, 95 (63%) also received pharmacologic thromboprophylaxis.
Of the 136 patients who did not receive anticoagulant prophylaxis but who had no contraindication for its use, 80 (58.8%) were at high risk based on Padua scoring. The overall rate of pharmacologic prophylaxis in patients without contraindications was 74.2% (392 of 528 patients).
Predictive Factors
On multivariate logistic regression analysis among patients without contraindications, factors predictive of increased likelihood of receiving thromboprophylaxis were history vs no history of prior venous thromboembolism (odds ratio [OR] = 5.80, P = .002), nonhematologic vs hematologic malignancy (OR = 2.34, P < .001), acute infection or rheumatologic disorder vs other diagnoses (OR = 1.92, P = .018), and trauma or surgery vs none within last 6 months (OR = 1.74, P = .056) and those associated with decreased likelihood were admission for cancer therapy vs other reasons (OR = 0.37, P < .001) and central venous catheter vs none (OR = 0.56, P = .031).
The investigators concluded, “We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in hospitalized patients with cancer is commonly prescribed without regard to the presence or absence of concomitant risk factors for venous thromboembolism.”
Jeffrey I. Zwicker, MD, Beth Israel Deaconess Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by a National Institutes of Health award, Harvard University and its affiliated academic health care centers, and a Scott Hamilton CARES Initiative grant. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
