Appropriate thromboprophylaxis in hospitalized cancer patients

Abstract

Background: Cancer is associated with an increased risk of venous thromboembolism (VTE) in hospitalized patients. Despite availability of evidence-based guidelines recommending thromboprophylaxis in cancer patients, many cancer patients do not receive appropriate thromboprophylaxis. This study provides a large, real-world analysis of the rates of thromboprophylaxis use in hospitalized cancer patient discharges.

Methods: Hospital discharge information from the Premier Perspective inpatient database from January 2002-September 2005 was used. Included discharges had a principal diagnosis of cancer, were aged 40 years or older, had a length of hospital stay of 6 days or more, and had no contraindications for anticoagulation. The rate of appropriate VTE prophylaxis was determined according to the 7th American College of Chest Physicians guidelines, taking into account mechanical compression and chemoprophylaxis, dosage of anticoagulant, and duration of therapy.

Results: A total of 72,337 cancer discharges with an indication for thromboprophylaxis were identified (30,124 surgical, 42,213 nonsurgical). The overall rate of any level of VTE prophylaxis was 53.6%; however, the rate of appropriate thromboprophylaxis (according to the 7th ACCP guidelines) was 27.0% (27.0% surgical, 27.1% nonsurgical). The most common reason for inappropriate prophylaxis (46.0% of all discharges) was no prophylaxis received, despite having no contra-indication to anticoagulation.

Conclusions: This study highlights that despite the presence of evidence-based guidelines, appropriate thromboprophylaxis is severely underused in all types of at-risk cancer patients. Greater efforts are needed to improve the implementation of guidelines, and to ensure that more cancer patients receive appropriate thromboprophylaxis.