Retrospective evaluation of venous thromboembolism prophylaxis in the adult cancer population.
OBJECTIVE
Hospitalized cancer patients are at an increased risk for venous thromboembolism (VTE) and it is recommended they receive pharmacologic prophylaxis unless otherwise contraindicated. The majority of data supporting this recommendation comes from sub-group analyses and extrapolation of data gathered in general medical/surgical patients. This study seeks to assess the safety and efficacy of VTE prophylaxis in cancer patients admitted to our institution.


METHODS
Charts of patients 18-89 years of age receiving VTE prophylaxis with unfractionated heparin, low molecular weigh heparin, or fondaparinux while admitted to Karmanos Cancer Center between September and October 2007 were retrospectively reviewed. Risk factors for VTE were assessed and the efficacy/safety of the prophylactic agents was compared.


RESULTS
One-hundred and eighty consecutive patients were identified. The average number of risk factors for developing VTE was 3-4 per hospital admission in addition to an active cancer diagnosis. Three VTEs occurred in the heparin group with two patients experiencing a VTE during their admission and one experiencing a VTE within 1 month after discharge. Four (2.6%) patients receiving heparin had a major bleeding event. Minor bleeding occurred in 14.3, 11.5, and 22.2% of patients receiving heparin, enoxaparin, and fondaparinux, respectively.


CONCLUSIONS
This retrospective study showed cancer patients are at increased risk for VTE, typically with 3-4 risk factors per admission. VTEs were uncommon; however, three patients receiving heparin experienced a VTE and four had a major bleeding event. Minor bleeding rates were similar among groups.
Reeves
David
D
Department of Pharmacy, Karmanos Cancer Center, 4100 John R, Detroit, MI 48201, USA. reevesd@karmanos.org
Liu
Chin Y
CY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D000077425:Fondaparinux; D006470:Hemorrhage / Q000150:complications / Q000453:epidemiology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011134:Polysaccharides / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D055815:Young Adult
D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux