title: Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers: a prospective, cross-sectional, multicenter study.
abstract: OBJECTIVE
  Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer.
  
  
  METHODS
  We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization.
  
  
  RESULTS
  A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P=.007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P<.001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System.
  
  
  CONCLUSIONS
  We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in hospitalized patients with cancer is commonly prescribed without regard to the presence or absence of concomitant risk factors for VTE.
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH. jzwicker@bidmc.harvard.edu.
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Zwicker
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Adam
authors.initials: A
authors.lastname: Rojan
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Federico
authors.initials: F
authors.lastname: Campigotto
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Nadia
authors.initials: N
authors.lastname: Rehman
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Renee
authors.initials: R
authors.lastname: Funches
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Gregory
authors.initials: G
authors.lastname: Connolly
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Webster
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Anita
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Dalia
authors.initials: D
authors.lastname: Mobarek
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Charles
authors.initials: C
authors.lastname: Faselis
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Donna
authors.initials: D
authors.lastname: Neuberg
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Rickles
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Ted
authors.initials: T
authors.lastname: Wun
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
authors.affiliation: Jeffrey I. Zwicker, Adam Rojan, and Renee Funches, Beth Israel Deaconess Medical Center and Harvard Medical School; Federico Campigotto and Donna Neuberg, Dana-Farber Cancer Institute, Boston, MA; Nadia Rehman and Ted Wun, University of California at Davis School of Medicine; Nadia Rehman and Ted Wun, VA Northern California Health Care System, Sacramento, CA; Gregory Connolly, University of Rochester Medical Center, Rochester, NY; Jonathan Webster and Michael B. Streiff, Johns Hopkins University School of Medicine, Baltimore, MD; Anita Aggarwal, Dalia Mobarek, Charles Faselis, and Frederick R. Rickles, Veterans Administration Medical Center and The George Washington University, Washington, DC; and Alok A. Khorana, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Alok A
authors.initials: AA
authors.lastname: Khorana
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000188:drug therapy; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D013923:Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants