Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers: A prospective, cross-sectional, multicenter study

Jeffrey I. Zwicker, Adam Rojan, Federico Campigotto, Nadia Rehman, Renee Funches, Gregory Connolly, Jonathan Webster, Anita Aggarwal, Dalia Mobarek, Charles Faselis, Donna Neuberg, Frederick R. Rickles, Theodore Wun, Michael B. Streiff, Alok A. Khorana

Research output: Contribution to journalArticle

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Abstract

Purpose: Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. Patients and Methods: We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. Results: A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P = .007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P < .001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System. Conclusion: We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in hospitalized patients with cancer is commonly prescribed without regard to the presence or absence of concomitant risk factors for VTE.

Original languageEnglish (US)
Pages (from-to)1792-1796
Number of pages5
JournalJournal of Clinical Oncology
Volume32
Issue number17
DOIs
StatePublished - Jun 10 2014

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Multicenter Studies
Cross-Sectional Studies
Neoplasms
Venous Thromboembolism
Odds Ratio
Hematologic Neoplasms
Practice Guidelines
Anticoagulants
Prescriptions
Hospitalization
Retrospective Studies

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers : A prospective, cross-sectional, multicenter study. / Zwicker, Jeffrey I.; Rojan, Adam; Campigotto, Federico; Rehman, Nadia; Funches, Renee; Connolly, Gregory; Webster, Jonathan; Aggarwal, Anita; Mobarek, Dalia; Faselis, Charles; Neuberg, Donna; Rickles, Frederick R.; Wun, Theodore; Streiff, Michael B.; Khorana, Alok A.

In: Journal of Clinical Oncology, Vol. 32, No. 17, 10.06.2014, p. 1792-1796.

Research output: Contribution to journalArticle

Zwicker, JI, Rojan, A, Campigotto, F, Rehman, N, Funches, R, Connolly, G, Webster, J, Aggarwal, A, Mobarek, D, Faselis, C, Neuberg, D, Rickles, FR, Wun, T, Streiff, MB & Khorana, AA 2014, 'Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers: A prospective, cross-sectional, multicenter study', Journal of Clinical Oncology, vol. 32, no. 17, pp. 1792-1796. https://doi.org/10.1200/JCO.2013.53.5336
Zwicker, Jeffrey I. ; Rojan, Adam ; Campigotto, Federico ; Rehman, Nadia ; Funches, Renee ; Connolly, Gregory ; Webster, Jonathan ; Aggarwal, Anita ; Mobarek, Dalia ; Faselis, Charles ; Neuberg, Donna ; Rickles, Frederick R. ; Wun, Theodore ; Streiff, Michael B. ; Khorana, Alok A. / Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers : A prospective, cross-sectional, multicenter study. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 17. pp. 1792-1796.
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abstract = "Purpose: Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. Patients and Methods: We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. Results: A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9{\%}) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2{\%} (95{\%} CI, 70.4{\%} to 78.0{\%}; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95{\%} CI, 1.43 to 3.82; P = .007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95{\%} CI, 0.22 to 0.61; P < .001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8{\%} were considered to be high risk by the Padua Scoring System. Conclusion: We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in hospitalized patients with cancer is commonly prescribed without regard to the presence or absence of concomitant risk factors for VTE.",
author = "Zwicker, {Jeffrey I.} and Adam Rojan and Federico Campigotto and Nadia Rehman and Renee Funches and Gregory Connolly and Jonathan Webster and Anita Aggarwal and Dalia Mobarek and Charles Faselis and Donna Neuberg and Rickles, {Frederick R.} and Theodore Wun and Streiff, {Michael B.} and Khorana, {Alok A.}",
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T1 - Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers

T2 - A prospective, cross-sectional, multicenter study

AU - Zwicker, Jeffrey I.

AU - Rojan, Adam

AU - Campigotto, Federico

AU - Rehman, Nadia

AU - Funches, Renee

AU - Connolly, Gregory

AU - Webster, Jonathan

AU - Aggarwal, Anita

AU - Mobarek, Dalia

AU - Faselis, Charles

AU - Neuberg, Donna

AU - Rickles, Frederick R.

AU - Wun, Theodore

AU - Streiff, Michael B.

AU - Khorana, Alok A.

PY - 2014/6/10

Y1 - 2014/6/10

N2 - Purpose: Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. Patients and Methods: We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. Results: A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P = .007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P < .001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System. Conclusion: We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in hospitalized patients with cancer is commonly prescribed without regard to the presence or absence of concomitant risk factors for VTE.

AB - Purpose: Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. Patients and Methods: We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. Results: A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P = .007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P < .001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System. Conclusion: We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in hospitalized patients with cancer is commonly prescribed without regard to the presence or absence of concomitant risk factors for VTE.

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