Abstract 2565

Introduction:

Cancer patients have a 4 to 6-fold higher risk of suffering Venous Thromboembolism (VTE), the second cause of death in hospitalized cancer patients. These patients are considered as high risk for VTE by the ACCP guidelines, so the pharmacological prophylaxis is indicated if there is no contraindication. A study carried out at our hospital between 2003 and 2004 showed a low use of thromboprophylaxis in this group of patients. The implementation of diverse strategies may improve this prophylaxis. A continuing medical education program was introduced to medical interns and internal medicine residents between 2005 and 2009 with this purpose. The objective of this study was to evaluate changes in the use of thromboprophylaxis in cancer patients hospitalized between 2008 and 2009.

Methods:

A six-month seminar program was implemented for medical interns and internal medicine residents enhanced by daily visits to the patient rooms by the medical staff who supervised the correct use of thromboprophylaxis.

The results were based on a retrospective analysis of clinical data of medical and surgical patients diagnosed with cancer hospitalized at the University of Chile Clinical Hospital in the 2003–2004 period (Group A) and in the period 2008–2009 (Group B) (Table 1).

Table 1
Group ResultsAB
N° of Patients (n) 366 316 
Median Age (years, median) 63 63 
Metastatic Cancer (%) 25.9% 23.7% 
>=1 VTE Risk Factor (%) 64.7% 56.3% 
Hospital Stay (days, median) 9 9 
Use of Thromboprophylaxis (A vs B p< 0.001, chi2)   
    Low Molecular Weight Heparin (Dalteparine) (%) 33% 83.2% 
    Unfractionated Heparin (%) 32.8% 3.2% 
    Without Thromboprophylaxis (%) 34.2% 13.6% 
Mortality (%) 9.5% 6% 
Major Bleeding (%) 1.9% 2.2% 
VTE Events (%) 11 (3%) 4 (1.8%) 
VTE Events without Thromboprophylaxis (n) 9/11 0/4 
Group ResultsAB
N° of Patients (n) 366 316 
Median Age (years, median) 63 63 
Metastatic Cancer (%) 25.9% 23.7% 
>=1 VTE Risk Factor (%) 64.7% 56.3% 
Hospital Stay (days, median) 9 9 
Use of Thromboprophylaxis (A vs B p< 0.001, chi2)   
    Low Molecular Weight Heparin (Dalteparine) (%) 33% 83.2% 
    Unfractionated Heparin (%) 32.8% 3.2% 
    Without Thromboprophylaxis (%) 34.2% 13.6% 
Mortality (%) 9.5% 6% 
Major Bleeding (%) 1.9% 2.2% 
VTE Events (%) 11 (3%) 4 (1.8%) 
VTE Events without Thromboprophylaxis (n) 9/11 0/4 
View Large

Exclusion Criteria at Admission: VTE diagnosis, use of anticoagulants, thromboprophylaxis contraindication and age <18 years.

Conclusion:

The risk for VTE is very high in hospitalized cancer patients and is associated with an increased risk of recurrent thrombosis. Several international medical organizations (NCCN, ASCO, ESMO, ASH) call for improving thromboprophylaxis in this high-risk population.

The introduction of an active medical educational program addressed to medical interns and internal medicine residents resulted in a significant increase in the proportion of hospitalized cancer patients who received appropriate prophylaxis in accordance with the ACCP guidelines from 65.8% at the start of the study to 86.4% (p< 0.001) after 24 months.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
cancer, educational programs, hospitals, university, south america, venous thromboembolism, thromboprophylaxis, anticoagulants, hemorrhage, low-molecular-weight heparin, malignant neoplasm, disseminated

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
Sign in via your Institution