Use of thromboprophylaxis in palliative care patients: a survey among experts in palliative care, oncology, intensive care, and anticoagulation.
Study-based guidelines on thromboprophylaxis are not available for palliative care patients. The authors asked a panel of academic medical experts in palliative care, oncology, blood coagulation, and intensive care to select a prophylactic regimen out of 5 predefined options for a virtual patient with advanced bronchial cancer in different clinical settings. Primary prophylaxis for venous thromboembolism was withdrawn by all physicians when the patient had a Karnovsky's index of 10 and was described as dying. It was given by 25% of physicians when the patient had a Karnovsky's index of 20 and by 85% when Karnovsky's index 40 was still 40. Similar results were obtained in the situation of secondary prophylaxis of venous thromboembolism and when the patient was described as having a history of chronic atrial fibrillation. This data clearly show that thromboprophylaxis is delivered according to a compound estimate of risks and benefits of such prophylaxis in a specific palliative care situation.
Kierner
Katharina A
KA
Unit of Palliative Care, Department of Medicine I, Medical University of Vienna, Austria.
Gartner
Verena
V
Schwarz
Maria
M
Watzke
Herbert H
HH
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control; D001291:Attitude of Health Personnel; D001317:Austria; D001984:Bronchial Neoplasms / Q000150:complications; D003422:Critical Care / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control; D028761:Withholding Treatment
D000925:Anticoagulants; D005343:Fibrinolytic Agents