Thromboprophylaxis in medically ill patients at risk for venous thromboembolism

Burleigh, E; Wang, Cheng; Foster, David A.; Heller, Sivana; Dunn, Dennis J.; Safavi, Kaveh; Griffin, Brian P.; Smith, Jeff

doi:10.2146/ajhp060390

Cited by 74 publications

(78 citation statements)

References 25 publications

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“…Despite the recommendations of those and other guidelines, thromboprophylaxis remains underused in hospitalized patients with cancer [53][54][55] . In fact, the probability of receiving appropriate thromboprophylaxis has been reported to be lower in patients with cancer than in non-cancer patients 56 .…”

Section: Thromboprophylaxis In Hospitalized Medical Patients With Cancermentioning

confidence: 99%

Cancer and Venous Thromboembolic Disease: From Molecular Mechanisms to Clinical Management

et al. 2014

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bleeding, and disseminated intravascular coagulation 2 . Prevention and management of those complications in cancer patients can significantly affect patient treatment, prognosis, and quality of life.Venous thromboembolism (vte), which includes deep venous thrombosis (dvt) and pulmonary embolism, might precede or coincide with a diagnosis of cancer. In this patient group, vte can potentially complicate surgery, hospitalization, or systemic chemotherapy 3-5 . Risk for vte is increased by a factor of approximately 6 in patients with cancer compared with non-cancer patients, and patients with cancer account for 20% of all newly diagnosed cases of vte 6 . Postmortem studies suggest that the incidence of vte in cancer patients might be as high as 50%, in keeping with the finding that, after cancer itself, vte represents the second leading cause of death in hospitalized patients with cancer 7-9 .Venous thromboembolism is associated with high morbidity, mortality, and economic burden. Its diagnosis and management can interrupt essential cancer therapy and cause potentially serious bleeding complications 10 . Moreover, approximately 25% of cancer patients with vte require readmission because of bleeding or recurrent vte 11,12 . MECHANISMS UNDERLYING THE CANCER-ASSOCIATED PROTHROMBOTIC PHENOTYPEDirect and indirect mechanisms contribute to the pathogenesis of cancer-associated vte 13-15 (Figure 1

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Section: Thromboprophylaxis In Hospitalized Medical Patients With Cancermentioning

confidence: 99%

Cancer and Venous Thromboembolic Disease: From Molecular Mechanisms to Clinical Management

et al. 2014

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“…Across all 11 identified studies, anticoagulation resulted in a significantly lower overall risk for mortality (RR, 0.905; 95% CI, 0.847-0.967; p ϭ .003). A retrospective analysis based on nearly 2.5 million patient hospital discharges, obtained from a large U.S. inpatient database, has shown that the mortality rate in cancer patients who received thromboprophylaxis with UFH or LMWH was significantly lower than for cancer patients who did not receive prophylaxis (risk-adjusted mortality rate, 7.4% versus 8.6%, respectively; p Ͻ .001) [46]. Therefore, thromboprophylaxis in cancer patients might also improve their survival outcomes, possibly by preventing VTE and by additional antitumor effects.…”

Section: Antitumor Effects Of Lmwhsmentioning

confidence: 99%

“…A 4-year retrospective study of thromboprophylaxis practices in medically ill patients across the U.S. revealed low rates of thromboprophylaxis for patient groups who are at risk for VTE, including cancer patients [46]. Although the use of prophylaxis in cancer patients improved slightly between 2001 and 2004, from 18% to 25%, it still remained at an unacceptably low percentage [46].…”

Section: Underuse Of Prophylaxis In Hospitalized Cancer Patientsmentioning

confidence: 99%

The NCCN Clinical Practice Guidelines on Venous Thromboembolic Disease: Strategies for Improving VTE Prophylaxis in Hospitalized Cancer Patients

Khorana

2007

The Oncologist

109

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After completing this course, the reader will be able to:1. Discuss the importance of thromboprophylaxis in hospitalized cancer patients.2. Identify risk factors for cancer-associated thrombosis.3. Identify strategies to improve compliance with prophylaxis recommended by NCCN guidelines.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThe risk for venous thromboembolism (VTE) is high in hospitalized cancer patients, and is associated with an elevated risk for recurrent thrombosis, bleeding complications, and use of health care resources. Thromboembolism is the second leading cause of death in hospitalized cancer patients. Thromboprophylaxis with unfractionated heparin or lowmolecular-weight heparins has been clinically proven to reduce the risk for VTE and improve outcomes. However, VTE prophylaxis continues to be underprescribed in cancer patients. Recognizing the clinical burden of VTE in cancer patients, the National Comprehensive Cancer Network (NCCN) recently released guidelines for VTE prevention and management. These NCCN guidelines recommend evidencebased prophylactic anticoagulant therapy for all patients admitted to hospital with a diagnosis of cancer who do not have contraindications to anticoagulant use. However, there continue to be barriers to the implementation of clinical practice guidelines and appropriate use of VTE prophylaxis. Multifaceted active educational and electronic interventions are necessary to raise awareness and reduce the burden of cancer-associated thrombosis and its attendant consequences.

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“…В другом исследовании [29] проведен анализ стои-мости лечения 153 552 больных, получавших НМГ или НФГ в остром периоде ишемического инсульта. Средняя стоимость применения НМГ у 1 пациента составила 803±993 долл.…”

Section: о б з о р ыunclassified

Prevention of venous thromboembolic events in ischemic stroke

Парфенов¹

2013

Neurology, Neuropsychiatry, Psychosomatics

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Thromboprophylaxis in medically ill patients at risk for venous thromboembolism

Cited by 74 publications

References 25 publications

Cancer and Venous Thromboembolic Disease: From Molecular Mechanisms to Clinical Management

Cancer and Venous Thromboembolic Disease: From Molecular Mechanisms to Clinical Management

The NCCN Clinical Practice Guidelines on Venous Thromboembolic Disease: Strategies for Improving VTE Prophylaxis in Hospitalized Cancer Patients

Prevention of venous thromboembolic events in ischemic stroke

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