Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement |
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Authors: | Alpesh N Amin Steven B Deitelzweig |
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Institution: | (1) University of California, Irvine, 101 The City Drive South, Building 26, Room 1005, ZC-4076aH, Orange, CA 92868, USA;(2) Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA |
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Abstract: | Venous thromboembolism (VTE), a common complication in patients with cancer, is associated with increased risk of morbidity,
mortality, and recurrent VTE. Risk factors for VTE in cancer patients include the type and stage of cancer, comorbidities,
age, major surgery, and active chemotherapy. Evidence-based guidelines for thromboprophylaxis in cancer patients have been
published: the National Comprehensive Cancer Network and American Society for Clinical Oncology guidelines recommend thromboprophylaxis
for hospitalized cancer patients, while the American College of Chest Physician guidelines recommend thromboprophylaxis for
surgical patients with cancer and bedridden cancer patients with an acute medical illness. Guidelines do not generally recommend
routine thromboprophylaxis in ambulatory patients during chemotherapy, but there is evidence that some of these patients are
at risk of VTE; some may be at higher risk while on active chemotherapy. Approaches are needed to identify those patients
most likely to benefit from thromboprophylaxis, and, to this end, a risk assessment model has been developed and validated.
Despite the benefits, many at-risk patients do not receive any thromboprophylaxis, or receive prophylaxis that is not compliant
with guideline recommendations. Quality improvement initiatives have been developed by the Centers for Medicare and Medicaid
Services, National Quality Forum, and Joint Commission to encourage closure of the gap between guideline recommendations and
clinical practice for prevention, diagnosis, and treatment of VTE in hospitalized patients. Health-care institutions and providers
need to take seriously the burden of VTE, improve prophylaxis rates in patients with cancer, and address the need for prophylaxis
across the patient continuum. |
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