PURPOSE: Studies have shown that long-term treatment with subcutaneous (SC) low-molecular-weight-heparin (LMWH) is more effective than vitamin-K-antagonist (VKA) therapy for preventing recurrent venous-thromboembolism-events (VTE) in cancer patients with VTE. The Sixth American College of Chest Physicians (ACCP) Consensus Conference (2004) recommends that patients with cancer and VTE be treated with SC-LMWH for at least six months. Our main objective was to characterize the long-term VTE treatment strategies in hospitalized cancer patients with VTE.
METHODS: A medical chart review was preformed of all consecutive hospitalized patients with cancer and VTE between July 1, 2005 and June 30, 2006 at a large tertiary care center. The primary and secondary discharge diagnostic fields of medical charts were screened to identify cancer patients with VTE using the International Classification of Diseases for deep-vein-thrombosis (DVT), pulmonary-embolism (PE), and cancer (except non-melanoma skin cancer and carcinoma-in-situ of the cervix). Only patients with cancer and an objectively diagnosed DVT and PE were included for analysis. Initial VTE treatment was described as treatment initiated at the time of VTE diagnosis and long-term VTE treatment was defined as at discharge, death, or transfer to another institution/long-term care facility.
RESULTS: Of 57 patients with cancer and VTE, 48 (84%) were started on initial VTE treatment, and 9 (16%) received no initial treatment for reasons that included active or a perceived high risk of bleeding (n=3), presence of an isolated below knee DVT (n=5), and placement of an IVC filter for unknown reasons (n=1). Of the 48 patients who received initial treatment, 45 patients continued with long-term treatment and 3 patients had their initial therapy discontinued and an IVC filter inserted. Long-term treatment consisted of SC-LMWH in 26 patients (59%), VKA in 15 patients (33%), and unfractioned-heparin in 4 patients (9%).
CONCLUSION: Almost 60% of hospitalized cancer patients with VTE received ACCP-recommended long-term VTE treatment with SC-LMWH. For unclear reasons, one third of patients received non-recommended long-term VKA therapy.
CLINICAL IMPLICATIONS: Further study is needed to understand reasons for guideline non-compliance.
DISCLOSURE: Jian Wang, No Financial Disclosure Information; No Product/Research Disclosure Information