Elena Panizo1, Ana Alfonso1, Alberto García-Mouriz2, José M López-Picazo3, Ignacio Gil-Bazo3, José Hermida4, José A Páramo1, Ramón Lecumberri5. 1. Hematology Service, University Clinic of Navarra, Pamplona, Spain. 2. Informatics Department, University Clinic of Navarra, Pamplona, Spain. 3. Oncology Department, University Clinic of Navarra, Pamplona, Spain. 4. Division of Cardiovascular Sciences, Centre of Applied Medical Research, University of Navarra, Pamplona, Spain. 5. Hematology Service, University Clinic of Navarra, Pamplona, Spain. Electronic address: rlecumber@unav.es.
Abstract
INTRODUCTION: Current clinical practice guidelines do not recommend routine pharmacological thromboprophylaxis in cancer outpatients receiving chemotherapy. However, a high proportion of cancer-associated venous thromboembolism (VTE) events occur in this setting. There are scarce data on the use of thromboprophylaxis in ambulatory cancer patients in real clinical practice. MATERIAL AND METHODS: We conducted a single-center prospective study aimed to evaluate the use and factors influencing pharmacological prophylaxis in consecutive cancer patients receiving ambulatory chemotherapy. Patients were followed for 90 days after inclusion. RESULTS: A total of 1108 patients were included. According to the Khorana score, 45.8% patients were classified as low-risk, 47.4% intermediate-risk and 6.8% as high-risk. Outpatient pharmacological prophylaxis was administered at any time during follow-up to 157 patients (14.2%) with a median duration of 42 days (range 1-90). Main factors influencing thromboprophylaxis were: previous history of VTE (odds ratio [OR], 19.11; 95% CI, 9.61-37.98), intercurrent hospitalization (OR, 5.40; 95% CI, 3.57-8.16), and gastrointestinal or gynecologic cancer (OR, 1.76; 95% CI, 1.11-2.80 and OR, 2.34; 95% CI, 1.05-5.26, respectively). During follow-up 58 (5.2%) VTE events were observed. Independent predictors of VTE were the site of malignancy (OR, 3.04; 95%CI, 1.20-7.71 and OR, 2.47; 95%CI, 1.21-5.01 for pancreas and lung cancer, respectively) and previous VTE (OR, 4.23; 95%CI, 1.26-14.27). Outpatient prophylaxis was associated with a lower risk of VTE during follow-up (OR, 0.30; 95%CI, 0.10-0.95). CONCLUSIONS: Although the type of malignancy appears as the most relevant variable for decision-making, additional efforts are required to identify patients at particular high thrombosis risk.
INTRODUCTION: Current clinical practice guidelines do not recommend routine pharmacological thromboprophylaxis in cancer outpatients receiving chemotherapy. However, a high proportion of cancer-associated venous thromboembolism (VTE) events occur in this setting. There are scarce data on the use of thromboprophylaxis in ambulatory cancerpatients in real clinical practice. MATERIAL AND METHODS: We conducted a single-center prospective study aimed to evaluate the use and factors influencing pharmacological prophylaxis in consecutive cancerpatients receiving ambulatory chemotherapy. Patients were followed for 90 days after inclusion. RESULTS: A total of 1108 patients were included. According to the Khorana score, 45.8% patients were classified as low-risk, 47.4% intermediate-risk and 6.8% as high-risk. Outpatient pharmacological prophylaxis was administered at any time during follow-up to 157 patients (14.2%) with a median duration of 42 days (range 1-90). Main factors influencing thromboprophylaxis were: previous history of VTE (odds ratio [OR], 19.11; 95% CI, 9.61-37.98), intercurrent hospitalization (OR, 5.40; 95% CI, 3.57-8.16), and gastrointestinal or gynecologic cancer (OR, 1.76; 95% CI, 1.11-2.80 and OR, 2.34; 95% CI, 1.05-5.26, respectively). During follow-up 58 (5.2%) VTE events were observed. Independent predictors of VTE were the site of malignancy (OR, 3.04; 95%CI, 1.20-7.71 and OR, 2.47; 95%CI, 1.21-5.01 for pancreas and lung cancer, respectively) and previous VTE (OR, 4.23; 95%CI, 1.26-14.27). Outpatient prophylaxis was associated with a lower risk of VTE during follow-up (OR, 0.30; 95%CI, 0.10-0.95). CONCLUSIONS: Although the type of malignancy appears as the most relevant variable for decision-making, additional efforts are required to identify patients at particular high thrombosis risk.
Authors: R Figueroa; A Alfonso; J López-Picazo; I Gil-Bazo; A García-Mouriz; J Hermida; J A Páramo; R Lecumberri Journal: Clin Transl Oncol Date: 2018-11-16 Impact factor: 3.405
Authors: Rocío Figueroa; Ana Alfonso; José López-Picazo; Ignacio Gil-Bazo; Alberto García-Mouriz; José Hermida; José Antonio Páramo; Ramón Lecumberri Journal: PLoS One Date: 2018-08-02 Impact factor: 3.240
Authors: Frits I Mulder; Matteo Candeloro; Pieter W Kamphuisen; Marcello Di Nisio; Patrick M Bossuyt; Noori Guman; Kirsten Smit; Harry R Büller; Nick van Es Journal: Haematologica Date: 2019-01-03 Impact factor: 11.047