Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement
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REVIEW
Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement Alpesh N. Amin • Steven B. Deitelzweig
Received: 23 February 2011 / Accepted: 16 May 2011 / Published online: 31 May 2011 Ó Springer-Verlag 2011
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. Keywords Cancer Venous thromboembolism Prophylaxis Anticoagulation Quality improvement
Introduction The association between cancer and venous thromboembolism (VTE) is well established [1–4]. Furthermore, it is known that VTE has considerable clinical consequences in patients with cancer, including increased risk of morbidity, mortality, and recurrent VTE [5–8]. There are several risk factors for cancer-associated VTE and appropriate risk assessment models to identify those patients at high risk for VTE have been developed to allow for targeted thromboprophylaxis and improve prognosis [9–11]. This review aims to discuss the burden and risks of VTE in cancer patients, describe current strategies for VTE prevention, and identify opportunities to improve the quality of these approaches.
A. N. Amin (&) University of California, Irvine, 101 The City Drive South, Building 26, Room 1005, ZC-4076aH, Orange, CA 92868, USA e-mail: [email protected]
Incidence and risk of VTE in patients
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