Thromboprophylaxis for inpatient with advanced cancer receiving palliative care: A retrospective study

Abstract

Objectives The benefits and risks of thromboprophylaxis usage in patients with advanced cancer at the end of their lives remain unknown, especially with the lack of randomized studies. This study aimed to describe the clinical use of thromboprophylaxis in those patients under palliative care. Methods A retrospective cohort study. It was performed on patients admitted to the Palliative Care Center. Results A total of 719 patients were enrolled in the study. The mean age was 62.97 (13.65) years. Venous thromboembolism (VTE) incidence was 5.4% (n = 39). At the time of admission, 31.29% (n = 225) of patients were on thromboprophylaxis. At death time, 17.5% (n = 126) of patients were on thromboprophylaxis (41.3% on primary and 58.7% on secondary thromboprophylaxis). The incidence of clinically suspected fatal VTE was 6.5% (n = 47). Surprisingly, clinically suspected VTE was higher statistically in patients with thromboprophylaxis rather than in non‐thromboprophylaxis (p < .001). By using linear regression, only higher PPI scores on admission were independent negative predictors of length of stay (OR:4.429, 95% CI: 5.460–3.398, p < .001). The development of clinically suspected fatal VTE, whatever the status of thromboprophylaxis, did not affect the length of stay. Conclusions Thromboprophylaxis does not decrease the risk of clinically suspected fatal VTE in patients with advanced disease in their terminal phase. Patients with poor performance status and a short prognosis are unlikely to benefit from thromboprophylaxis.

Symptoms and prophylaxis of venous thromboembolism in the population of cancer and hospice patients-what is known?

“…The incidence of clinically suspected fatal VTE was 6.5%, and statistically it was higher in the group of patients taking antithrombotic prophylaxis than in the group of people who were not taking it. 28 The authors of another small prospective study on a group of 127 patients whose life expectancy was shorter than 6 months found that primary antithrombotic prophylaxis may not be included or even safely discontinued in patients previously taking it who were admitted to a palliative care unit. Of all participating patients, 41 (32.3%) were taking prophylaxis on admission.…”

“…Al.-Ansari et al 28 719 patients Cancer patients with a short expected survival time will not benefit from the use of prophylaxis, because it does not reduce the risk of fatal VTE in patients in the terminal phase of cancer. 9…”