Skip to main content
Top
Published in: Supportive Care in Cancer 9/2012

01-09-2012 | Original Article

Thromboprophylaxis in patients receiving inpatient palliative care: a survey of present practice in Austria

Authors: Verena Gartner, Katharina A. Kierner, Astrid Namjesky, Birgit Kum-Taucher, Bernhard Hammerl-Ferrari, Herbert H. Watzke, Cornelia Stabel, for the AUPACS group

Published in: Supportive Care in Cancer | Issue 9/2012

Login to get access

Abstract

Background

There is limited data on the use of thromboprophylaxis in patients with advanced cancer. We therefore aimed to study the practice of thromboprophylaxis in palliative care units in Austria.

Methods

We monitored use, indication, and contraindications to thromboprophylaxis in 134 patients hospitalized in 21 palliative care units in a prospective, cross-sectional study.

Results

Forty-seven percent of patients were on low molecular weight heparin on the day of the study for primary or secondary thromboembolism. Thromboprophylaxis had been withdrawn in 18% of the patients upon admission to the palliative care unit. Contraindications for thromboprophylaxis were present in 27% of all patients. Cancer was present in 86% of the patients. The use of thromboprophylaxis was similar in cancer patients and in non-cancer patients (49% vs. 42%). Contraindications for thromboprophylaxis were present in 24% of all cancer patients. Significantly more bedridden cancer patients had contraindications for prophylaxis when compared with mobile cancer patients (35% vs. 16%; p = 0.03). Low performance status was by far the most frequent contraindication among these patients (89%). Seventy-one percent of all bedridden cancer patients were treated in accordance with common guidelines for thromboprophylaxis when contraindications were taken into account. Eighty-seven percent of patients who had been involved in decision making opted for getting prophylaxis.

Conclusions

Our data reveal that about half of all cancer patients in palliative care units are treated with thromboprophylaxis. Low performance status was the most frequent contraindication for thromboprophylaxis.
Literature
1.
go back to reference Korte W (2008) Cancer and thrombosis: an increasingly important association. Support Care Cancer 16:223–228PubMedCrossRef Korte W (2008) Cancer and thrombosis: an increasingly important association. Support Care Cancer 16:223–228PubMedCrossRef
2.
go back to reference Bick RL (1978) Alterations of haemostasis with malignancy: etiology, pathophysiology, diagnosis and management. Semin Thromb Hemost 5:1–26PubMed Bick RL (1978) Alterations of haemostasis with malignancy: etiology, pathophysiology, diagnosis and management. Semin Thromb Hemost 5:1–26PubMed
3.
go back to reference Shen VS, Pollak EW (1980) Fatal pulmonary embolism in cancer patients: is heparin prophylaxis justified? South Med J 73:841–843PubMedCrossRef Shen VS, Pollak EW (1980) Fatal pulmonary embolism in cancer patients: is heparin prophylaxis justified? South Med J 73:841–843PubMedCrossRef
4.
go back to reference Khorana AA, Gregory C, Connolly GC (2009) Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol 27:4839–4847PubMedCrossRef Khorana AA, Gregory C, Connolly GC (2009) Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol 27:4839–4847PubMedCrossRef
5.
go back to reference Debourdeau P, Elalamy I, De Raignac A, Meria P, Gornet JM (2008) Long-term use of daily subcutaneous low molecular weight heparin in cancer patients with venous thromboembolism: why hesitate any longer? Support Care Cancer 16:1333–1341PubMedCrossRef Debourdeau P, Elalamy I, De Raignac A, Meria P, Gornet JM (2008) Long-term use of daily subcutaneous low molecular weight heparin in cancer patients with venous thromboembolism: why hesitate any longer? Support Care Cancer 16:1333–1341PubMedCrossRef
6.
go back to reference Khorana AA, Streiff MB, Farge D et al (2009) Venous thromboembolism prophylaxis and treatment in cancer: a consensus statement of major guidelines panels and call to action. J Clin Oncol 27:4919–4926PubMedCrossRef Khorana AA, Streiff MB, Farge D et al (2009) Venous thromboembolism prophylaxis and treatment in cancer: a consensus statement of major guidelines panels and call to action. J Clin Oncol 27:4919–4926PubMedCrossRef
7.
go back to reference Lyman GH, Khorana AA, Falanga A et al (2007) American society of clinical oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 25:5490–5505PubMedCrossRef Lyman GH, Khorana AA, Falanga A et al (2007) American society of clinical oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 25:5490–5505PubMedCrossRef
8.
go back to reference Geerts WH, Bergqvist D, Pineo GF et al (2008) Antithrombotic and thrombolytic therapy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133(6Suppl):110S–112S Geerts WH, Bergqvist D, Pineo GF et al (2008) Antithrombotic and thrombolytic therapy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133(6Suppl):110S–112S
9.
go back to reference Cohen AT, Tapson VF, Bergmann JF et al (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371:387–394PubMedCrossRef Cohen AT, Tapson VF, Bergmann JF et al (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371:387–394PubMedCrossRef
10.
go back to reference Tassinari D, Scarpi E, Tombesi P (2008) Controversial issues in thromboprophylaxis with low-molecular weight heparin. J Pain Symptom Manage 36:e3–e4PubMedCrossRef Tassinari D, Scarpi E, Tombesi P (2008) Controversial issues in thromboprophylaxis with low-molecular weight heparin. J Pain Symptom Manage 36:e3–e4PubMedCrossRef
11.
go back to reference Legault S, Tierney S, BScPharm Senecal I, Pereira J (2011) Evaluation of a thromboprophylaxis quality improvement project in a palliative care unit. J Pain Symptom Manage 41:503–510PubMedCrossRef Legault S, Tierney S, BScPharm Senecal I, Pereira J (2011) Evaluation of a thromboprophylaxis quality improvement project in a palliative care unit. J Pain Symptom Manage 41:503–510PubMedCrossRef
12.
go back to reference Noble S (2006) Acceptability of low molecular weight heparin thromboprophylaxis for inpatients receiving palliative care. BMJ 332:577–580PubMedCrossRef Noble S (2006) Acceptability of low molecular weight heparin thromboprophylaxis for inpatients receiving palliative care. BMJ 332:577–580PubMedCrossRef
13.
go back to reference Noble S, Finlay IG (2006) Have palliative care teams attitudes toward venous thromboembolism changed? J Pain Symptom Manage 32:1CrossRef Noble S, Finlay IG (2006) Have palliative care teams attitudes toward venous thromboembolism changed? J Pain Symptom Manage 32:1CrossRef
14.
go back to reference Kierner KA, Gartner V, Schwarz M, Watzke HH (2008) Use of thromboprophylaxis in palliative care patients: a survey among experts in palliative care, oncology, intensive care, and anticoagulation. Am J Hosp Palliat Care 25:127–133PubMedCrossRef Kierner KA, Gartner V, Schwarz M, Watzke HH (2008) Use of thromboprophylaxis in palliative care patients: a survey among experts in palliative care, oncology, intensive care, and anticoagulation. Am J Hosp Palliat Care 25:127–133PubMedCrossRef
15.
go back to reference McLean S, Ryan K, O’ Donnell JS (2010) Primary thromboprophylaxis in the palliative care setting: a qualitative systematic review. Palliat Med 24:386–395PubMedCrossRef McLean S, Ryan K, O’ Donnell JS (2010) Primary thromboprophylaxis in the palliative care setting: a qualitative systematic review. Palliat Med 24:386–395PubMedCrossRef
16.
go back to reference Gillon SG, Noble S, Ward J, Lodge KM, Koon S (2011) Primary thromboprophylaxis for hospice inpatients: who needs it? Palliat Med 25(7):701–705PubMedCrossRef Gillon SG, Noble S, Ward J, Lodge KM, Koon S (2011) Primary thromboprophylaxis for hospice inpatients: who needs it? Palliat Med 25(7):701–705PubMedCrossRef
17.
go back to reference Kakkar AK, Levine MN, Kadziola Z et al (2004) Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: the fragmin advanced malignancy outcome study (FAMOUS). J Clin Oncol 22:1944–1948PubMedCrossRef Kakkar AK, Levine MN, Kadziola Z et al (2004) Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: the fragmin advanced malignancy outcome study (FAMOUS). J Clin Oncol 22:1944–1948PubMedCrossRef
18.
go back to reference Noble SIR, Nelson A, Finlay IG (2008) Factors influencing hospice thromboprophylaxis policy: a qualitative study. Palliat Med 22:808–813PubMedCrossRef Noble SIR, Nelson A, Finlay IG (2008) Factors influencing hospice thromboprophylaxis policy: a qualitative study. Palliat Med 22:808–813PubMedCrossRef
Metadata
Title
Thromboprophylaxis in patients receiving inpatient palliative care: a survey of present practice in Austria
Authors
Verena Gartner
Katharina A. Kierner
Astrid Namjesky
Birgit Kum-Taucher
Bernhard Hammerl-Ferrari
Herbert H. Watzke
Cornelia Stabel
for the AUPACS group
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 9/2012
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-011-1330-6

Other articles of this Issue 9/2012

Supportive Care in Cancer 9/2012 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine