title: Primary thromboprophylaxis in hospices: the association between risk of venous thromboembolism and development of symptoms.
abstract: BACKGROUND
  Venous thromboembolism (VTE) risk assessment for adults admitted to hospital is commonplace, but the utility of assessment tools in patients admitted to hospices or palliative care units and prediction of symptomatic VTE is unknown.
  
  
  OBJECTIVE
  To investigate the relationship between risk of VTE and development of symptoms.
  
  
  METHODS
  Retrospective consecutive admission, case-note data from seven U.K. hospices were collected during an evaluation of a VTE risk assessment protocol using the Pan Birmingham Cancer Network palliative-modified Thromboembolic Risk Factors (THRIFT) Consensus Group criteria and presence/absence of a temporary elevated risk (TER) of VTE. Symptoms/signs during admission consistent with possible VTE were documented.
  
  
  RESULTS
  A total of 1164 case-notes were analyzed (age range 23-99; men 627). THRIFT risk was high in 13%, medium in 83%, and low in 4%; a TER was identified in 24%. In the "clinically relevant group" (no contraindication, not anticoagulated), where primary thromboprophylaxis could have been prescribed (n = 528), TER and symptoms were associated (21% symptoms with TER vs. 9% symptoms without TER: Chi-squared, P < 0.001). A high/moderate THRIFT score had a sensitivity of 98.4% (95% CI 91.3%-99.9%) and specificity of 5.8% (95% CI 3.9%-8.3%). The TER assessment had a more evenly balanced sensitivity (41.9%; 95% CI 29.5%-55.2%) and specificity (79%; 95% CI 75.0%-82.6%).
  
  
  CONCLUSIONS
  Hospice inpatients are at risk for VTE. TER alone is simpler to use and may be more useful in this population than the THRIFT but still has limitations regarding ability to predict symptoms.
authors: Palliative Medicine, Hull York Medical School, University of Hull, Hull, United Kingdom. Electronic address: miriam.johnson@hyms.ac.uk.
authors: Miriam J
authors: MJ
authors: Johnson
authors: Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, United Kingdom.
authors: Brian
authors: B
authors: McMillan
authors: York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom.
authors: Caroline
authors: C
authors: Fairhurst
authors: Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom.
authors: Rhian
authors: R
authors: Gabe
authors: Palliative Medicine, St. Gemma's Hospice Leeds, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom.
authors: Jason
authors: J
authors: Ward
authors: Palliative Medicine, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom.
authors: Jenny
authors: J
authors: Wiseman
authors: The Heart of Kent Hospice, Maidstone, United Kingdom.
authors: Bruce
authors: B
authors: Pollington
authors: Department of Palliative Medicine, Cardiff University, Newport, United Kingdom; Royal Gwent Hospital, Newport, United Kingdom.
authors: Simon I R
authors: SI
authors: Noble
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care; D006738:Hospices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D006113:United Kingdom; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control*; D055815:Young Adult
keywords: Palliative; hospice; primary thromboprophylaxis; venous thromboembolism