title: Primary thromboprophylaxis for hospice inpatients: who needs it?
abstract: Primary thromboprophylaxis (PTP) is a Department of Health priority in England. The NICE guidelines agree that PTP is inappropriate in the dying patient, but should be considered for those with reversible pathology. In the light of continued variation and uncertainty in UK hospice practice, we assessed PTP prescribing in three hospices. Case notes were reviewed from consecutive patients admitted before (300 patients) and after (350 patients) implementation of the Pan Birmingham Cancer Network (PBCN) venous thromboembolism prophylaxis (VTE) prevention guidelines. Just under half (43%; 40%) of patients had a contraindication to anticoagulation and PTP. Whilst just under a tenth (8.6%; 8.7%) in each group had a temporary increased risk of VTE, considerably fewer (3.6%; 6.3%) had a temporary increased risk of VTE without contraindication to PTP. Patients receiving PTP increased slightly from 1% to 3.6% and documentation of PTP decisions increased from 5% to 81%. Whilst the PBCN VTE tool is a useful tool to tailor an approach for this complex patient group, many questions remain. Clinical trials that include patients with advanced disease with relevant outcome measures are needed to help inform the clinicians who care for them.
authors.affiliation: Palliative Medicine, Yorkshire & Humber Deanery, UK. suziegillon@doctors.org.uk
authors.forename: Suzie
authors.initials: S
authors.lastname: Gillon
authors.forename: Simon
authors.initials: S
authors.lastname: Noble
authors.forename: Jason
authors.initials: J
authors.lastname: Ward
authors.forename: Keri-Michele
authors.initials: KM
authors.lastname: Lodge
authors.forename: Anne
authors.initials: A
authors.lastname: Nunn
authors.forename: Sim
authors.initials: S
authors.lastname: Koon
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D002637:Chest Pain; D000075202:Contraindications; D004417:Dyspnea; D004487:Edema; D005260:Female; D017051:Hospice Care / Q000379:methods*; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D011322:Primary Prevention; D012189:Retrospective Studies; D018570:Risk Assessment; D015912:Thrombolytic Therapy / Q000379:methods; D006113:United Kingdom; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants