Venous Thromboembolism Prophylaxis Practices in Acutely Ill Medical Patients with Either Previous Cancer or Currently Active Cancer: Findings from IMPROVE.

Background Patients with previous or current cancer have an increased risk for venous thromboembolism (VTE). However, little data is available on physician’s practices for providing VTE prophylaxis to these patients. The aim of this analysis of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) was to characterize VTE prophylaxis practices in acutely ill hospitalized medical patients who had previous cancer or currently active cancer. Methods Patient recruitment began in July 2002. Patients ≥18 years old and hospitalized for ≥3 days with an acute medical illness are enrolled consecutively. Exclusion criteria are: therapeutic antithrombotic agents or thrombolytics at admission, major surgery or trauma during 3 months prior to admission, and VTE treatment within 24 hours of admission. Results Data were from 4315 patients enrolled up to 30 June 2004 in 37 hospitals in 11 countries. 578 (13%) patients had currently active cancer (6% as the primary admission diagnosis). Patients with current cancer, previous cancer only, and no cancer were: 40%, 54% and 51% female, median (IQR) ages 72 (60–79), 77 (64–82) and 66 (47–80) years, median length of hospital stay 9 (5–18), 8 (5–12) and 8 (5–14) days, median duration of immobility 8 (5–19), 5 (4–11) and 6 (4–14) days (including immobility immediately prior to hospital admission). The percentages of patients with current or no cancer who received any pharmacologic prophylaxis were similar (see Table 1). However, aspirin was less likely to be prescribed, and intermittent pneumatic compression (IPC) more likely to be used in patients with current cancer than in those without cancer. Patients with previous cancer were more likely to receive pharmacologic prophylaxis, with increased use of unfractionated heparin (UFH) and aspirin, compared with patients without cancer. Conclusions Despite acutely ill medical patients with previous or current cancer having a higher risk for VTE, less than half received VTE prophylaxis, reflecting poor awareness of the benefits of prophylaxis. Physician’s perceptions of bleeding risks in cancer patients may influence prophylaxis practices; patients with current cancer were less likely to receive aspirin, but more likely to receive IPC, than patients without cancer. However, patients with previous cancer were more likely to receive pharmacologic prophylaxis than those without cancer, reflecting recognition by some physicians that these patients have an increased risk for VTE. Table 1. VTE prophylaxis in acutely ill medical patients with current, previous or no cancer VTE prophylaxis Current cancer (%) n=578 Previous cancer (%) n=266 No cancer (%) n=3471 *P<0.05, **P<0.01, ***P<0.001 (compared with patients with no cancer); †Some patients received >1 type of prophylaxis; ‡Without concomitant pharmacologic prophylaxis; ES, elastic stockings LMWH 24 24 23 UFH 10 21*** 13 Aspirin 1** 9** 4 Warfarin 0 1 1 Any pharmacologic prophylaxis† 34 46** 37 IPC‡ 7* 5 4 ES‡ 2 3 2