Miriam J Johnson1, Brian McMillan2, Caroline Fairhurst3, Rhian Gabe4, Jason Ward5, Jenny Wiseman6, Bruce Pollington7, Simon I R Noble8. 1. Palliative Medicine, Hull York Medical School, University of Hull, Hull, United Kingdom. Electronic address: miriam.johnson@hyms.ac.uk. 2. Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, United Kingdom. 3. York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom. 4. Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom. 5. Palliative Medicine, St. Gemma's Hospice Leeds, Leeds, United Kingdom; University of Leeds, Leeds, United Kingdom. 6. Palliative Medicine, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom. 7. The Heart of Kent Hospice, Maidstone, United Kingdom. 8. Department of Palliative Medicine, Cardiff University, Newport, United Kingdom; Royal Gwent Hospital, Newport, United Kingdom.
Abstract
CONTEXT: 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. OBJECTIVES: 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%). CONCLUSION: 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.
CONTEXT: 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. OBJECTIVES: 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%). CONCLUSION: 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: Christina A Kowalewska; Brie N Noble; Erik K Fromme; Mary Lynn McPherson; Kristi N Grace; Jon P Furuno Journal: J Palliat Med Date: 2017-06-05 Impact factor: 2.947
Authors: Marek Z Wojtukiewicz; Piotr Skalij; Piotr Tokajuk; Barbara Politynska; Anna M Wojtukiewicz; Stephanie C Tucker; Kenneth V Honn Journal: Cancers (Basel) Date: 2020-05-02 Impact factor: 6.639
Authors: Clare White; Simon I R Noble; Max Watson; Flavia Swan; Victoria L Allgar; Eoin Napier; Annmarie Nelson; Jayne McAuley; Jennifer Doherty; Bernadette Lee; Miriam J Johnson Journal: Lancet Haematol Date: 2019-02 Impact factor: 18.959