Prediction of venous thromboembolism in ambulatory patients with cancer receiving chemotherapy: An expanded thromboembolic risk score model.

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. e19551-e19551
Author(s):  
R. Labianca ◽  
G. Gasparini ◽  
S. Barni ◽  
M. Verso ◽  
E. Bonizzoni ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Risk Score ◽  
Thromboembolic Risk ◽  
Patients With Cancer ◽  
Ambulatory Patients ◽  
Score Model

scholarly journals Assessing the risk of venous thromboembolism (VTE) in ambulatory patients with cancer: Rationale and implementation of a pharmacist-led VTE risk assessment program in an ambulatory cancer centre

2021 ◽  
pp. 107815522110047
Author(s):  
Ryan Pelletier
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Risk Prediction ◽  
Risk Score ◽  
Prediction Models ◽  
Risk Prediction Models ◽  
Patients With Cancer ◽  
Assessment Program ◽  
Ambulatory Oncology ◽  
Ambulatory Patients

Objectives The objectives of this paper were to identify and compare clinical prediction models used to assess the risk of venous thromboembolism (VTE) in ambulatory patients with cancer, as well as review the rationale and implementation of a pharmacist-led VTE screening program using the Khorana Risk Score model in an ambulatory oncology centre in Sault Ste. Marie, Ontario, Canada. Data Sources PubMed was used to identify clinical practice guidelines and review articles discussing risk prediction models used to assess VTE risk in ambulatory patients with cancer. Data Summary Three commonly used VTE risk prediction models in ambulatory patients with cancer: the Khorana Risk Score, Vienna Cancer and Thrombosis Study (CATS) and Protecht Score, were identified via literature review. After considering guideline recommendations, site-specific factors (i.e. laboratory costs, time pharmacists spent calculating VTE risk) and evidence from the CASSINI and AVERT trials, a novel pharmacist-led VTE risk assessment program using the Khorana Risk Score was developed during a fourth-year PharmD clinical rotation at the Algoma District Cancer Program (ADCP) [ambulatory cancer care centre]. ADCP patients with a Khorana Risk Score of [Formula: see text] were referred to the hematologist for a full VTE workup. Considering limitations, inclusion and exclusion criteria of the CASSINI and AVERT trials, the hematologist and pharmacy team decided on appropriate initiation of thromboprophylaxis with a direct oral anticoagulant (DOAC). Conclusions The Khorana Risk Score was the chosen model used for the pharmacist-led VTE risk assessment program due to its user-friendly scoring algorithm, evidence from validation studies and clinical trials, as well as ease of integration into pharmacy workflow. More research is needed to determine if pharmacist-led VTE risk assessment programs will impact patient outcomes, such as morbidity and mortality, secondary to cancer-associated thrombosis.

scholarly journals Khorana Score: Νew Predictor of Early Mortality in Patients With Lung Adenocarcinoma

2018 ◽  
Vol 24 (8) ◽  
pp. 1347-1351 ◽  
Author(s):  
Ioannis Vathiotis ◽  
Evangelos P. Dimakakos ◽  
Paraskevi Boura ◽  
Angeliki Ntineri ◽  
Andiani Charpidou ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Adjuvant Chemotherapy ◽  
Lung Adenocarcinoma ◽  
Treatment Period ◽  
Predictive Value ◽  
First Line ◽  
Thromboembolic Risk ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
Significant Difference

Venous thromboembolism (VTE) is a typical complication in patients with lung cancer. Khorana score is an established tool for thromboembolic risk stratification of ambulatory patients with cancer undergoing outpatient chemotherapy. The aim of this study was to evaluate the predictive value of the Khorana score for VTE and death in patients with lung adenocarcinoma during first-line or adjuvant chemotherapy. Medical records of 130 patients with lung adenocarcinoma receiving first-line or adjuvant chemotherapy were retrospectively studied during the time period June 2013 to May 2015. Venous thromboembolism occurred in 13 (10.0%) patients. Thromboembolic events were significantly correlated with reduced survival during treatment period (hazard ratio [HR]: 3.24; 95% confidence interval [CI]: 1.11-9.49; P = .032). The VTE rates did not present statistically significant difference between different Khorana score groups ( P = .96). In univariate analysis, the risk of death during treatment period (median: 16 weeks) was 3.75 times higher in high-risk versus intermediate-risk patients (HR: 3.75, 95% CI: 1.36-10.36; P = .001) and had 2.25 times higher per point increase in the Khorana score (HR: 2.25, 95% CI: 1.36-3.73; P = .002); the above results were also reproduced in multivariate analysis. Khorana score represents a valuable tool for identifying patients with cancer in low thromboembolic risk but does not preserve its predictive value for higher risk individuals. Khorana score is an independent risk factor for death in patients with lung adenocarcinoma receiving first-line or adjuvant chemotherapy.

Recurrent thrombosis followed by Lazarus response in ROS1 rearranged NSCLC treated with crizotinib: a case report

2020 ◽  
Vol 106 (6) ◽  
pp. NP41-NP45
Author(s):  
Teresa Beninato ◽  
Giuseppe Lo Russo ◽  
Marina Chiara Garassino ◽  
Filippo De Braud ◽  
Marco Platania
Keyword(s):  
Venous Thromboembolism ◽  
Genetic Alterations ◽  
Small Cell Lung ◽  
Recurrent Thrombosis ◽  
Right Heart ◽  
Thromboembolic Risk ◽  
Patients With Cancer ◽  
Recurrent Venous Thromboembolism ◽  
Progressive Respiratory Failure ◽  
Alk Positive

Introduction: Patients with cancer have higher risk of thrombosis compared to the general population and particularly lung adenocarcinoma is considered at high risk for venous thromboembolism. Some targetable oncogenic drivers are supposed to further increase this risk. Case description: A 35-year-old man who had developed a recurrent venous thromboembolism and pulmonary embolism (PE) was diagnosed with ROS1 rearranged non-small cell lung cancer (NSCLC). While molecular examinations were ongoing, he developed progressive respiratory failure. For PE and thrombosis worsening with detection of right heart thrombus, he underwent therapy with unfractionated heparin. Despite initial good radiologic results, only with the start of crizotinib did the patient’s clinical condition significantly improve to configure a Lazarus response. Conclusions: Cancer diagnosis should always be considered in patients with unprovoked thrombosis and, if NSCLC is diagnosed, genetic alterations should be always sought after. A possible relation between venous thromboembolism and oncogenic drivers, particularly for ALK translocations, has been hypothesized. Similarly to ALK-positive NSCLC, ROS1 rearranged disease has been associated with an increased thromboembolic risk. Further studies are needed to better evaluate this relation and to evaluate the potential benefit of a prophylactic anticoagulating treatment in this subset of patients.

Predictors of thromboprophylaxis in hospitalised medical patients

2015 ◽  
Vol 113 (05) ◽  
pp. 1127-1134 ◽  
Author(s):  
David Spirk ◽  
Mathieu Nendaz ◽  
Drahomir Aujesky ◽  
Daniel Hayoz ◽  
Jürg H. Beer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Score ◽  
Low Risk ◽  
Medical Patients ◽  
Clinical Factors ◽  
Thromboembolic Risk ◽  
Factors Associated ◽  
Risk Patients

summaryBoth, underuse and overuse of thromboprophylaxis in hospitalised medical patients is common. We aimed to explore clinical factors associated with the use of pharmacological or mechanical thromboprophylaxis in acutely ill medical patients at high (Geneva Risk Score ≥ 3 points) vs low (Geneva Risk Score < 3 points) risk of venous thromboembolism. Overall, 1,478 hospitalised medical patients from eight large Swiss hospitals were enrolled in the prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study. The study is registered on ClinicalTrials. gov, number NCT01277536. Thromboprophylaxis increased stepwise with increasing Geneva Risk Score (p< 0.001). Among the 962 high-risk patients, 366 (38 %) received no thromboprophylaxis; cancer-associated thrombocytopenia (OR 4.78, 95 % CI 2.75–8.31, p< 0.001), active bleeding on admission (OR 2.88, 95 % CI 1.69–4.92, p< 0.001), and thrombocytopenia without cancer (OR 2.54, 95 % CI 1.31–4.95, p=0.006) were independently associated with the absence of prophylaxis. The use of thromboprophylaxis declined with increasing severity of thrombocytopenia (p=0.001). Among the 516 low-risk patients, 245 (48 %) received thromboprophylaxis; none of the investigated clinical factors predicted its use. In conclusion, in acutely ill medical patients, bleeding and thrombocytopenia were the most important factors for the absence of thromboprophylaxis among highrisk patients. The use of thromboprophylaxis among low-risk patients was inconsistent, without clearly identifiable predictors, and should be addressed in further research.

Can we use the Khorana risk score to predict venous thromboembolism in patients with cancer? A systematic review and meta-analysis

2018 ◽  
Vol 164 ◽  
pp. S234
Author(s):  
F.I. Mulder ◽  
M. Candeloro ◽  
N. van Es ◽  
M. Di Nisio ◽  
H.R. Büller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Risk Score ◽  
Meta Analysis ◽  
Patients With Cancer

Prevention of Thrombosis in Ambulatory Patients With Cancer

2009 ◽  
Vol 27 (29) ◽  
pp. 4885-4888 ◽  
Author(s):  
Punam Rana ◽  
Mark N. Levine
Keyword(s):  
Venous Thromboembolism ◽  
Clinical Care ◽  
Hematologic Malignancies ◽  
Anticoagulant Treatment ◽  
Antithrombotic Agents ◽  
Patients With Cancer ◽  
Prevention Of Thrombosis ◽  
Ambulatory Patients ◽  
Pharmacologic Prophylaxis ◽  
Anticoagulant Prophylaxis

Cancer patients with solid tumors or hematologic malignancies receive most of their cancer treatment as outpatients. Thromboembolism, when it occurs, complicates the clinical care of these patients because of the associated morbidity and the need for anticoagulant treatment. It would seem that prevention of venous thromboembolism in these patients would be worthwhile. However, to date there are relatively few trials of anticoagulant prophylaxis in ambulatory patients with cancer and it is not possible to recommend prophylaxis for most patients. Research is needed to better define a population at high enough risk to warrant pharmacologic prophylaxis and to develop new antithrombotic agents for this indication.

scholarly journals The Application of Current Proposed Venous Thromboembolism Risk Assessment Model for Ambulatory Patients With Cancer

2017 ◽  
Vol 24 (3) ◽  
pp. 429-433 ◽  
Author(s):  
Hikmat Abdel-Razeq ◽  
Asem Mansour ◽  
Salwa S. Saadeh ◽  
Mahmoud Abu-Nasser ◽  
Mohammad Makoseh ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Stage Iv ◽  
Assessment Model ◽  
Risk Scores ◽  
Patients With Cancer ◽  
Risk Assessment Models ◽  
Ambulatory Patients ◽  
Treatment Paradigm ◽  
Outpatient Settings

Venous thromboembolism (VTE) is a commonly encountered problem in patients with cancer. In recent years, cancer treatment paradigm has shifted with most therapy offered in ambulatory outpatient settings. Excess of half VTEs in patients with cancer occur in outpatient settings without prior hospitalization, where current practice guidelines do not recommend routine prophylaxis. Risk assessment models (RAMs) for VTE in such patients were recently introduced. This study aims to assess the practical application of one of these models in clinical practice. Medical records and hospital electronic database were searched for patients with cancer having VTE. Known risk factors were collected, and risk assessment was done using the Khorana RAM. Over a 10-year period, 346 patients developed VTE in ambulatory settings. Median age was 57 and 59.0% were females. Lower extremities were involved in 196 (56.6%), while 96 (27.7%) had pulmonary embolism. Most (76.6%) patients had stage IV disease, only 9.0% had stage I or II disease. Only 156 (45.1%) patients were on active chemotherapy, for whom Khorana risk assessment score was calculated. In these patients, high risk was identified in 31 (19.9%) patients, while 81 (51.9%) had intermediate risk and 44 (28.2%) had low risk. No patients were on prophylaxis prior to VTE. Most ambulatory patients with cancer who developed VTE were not on chemotherapy, and many of those who were on active treatment had low Khorana risk scores. This illustrates the need to modify the model or develop a new one that takes into consideration this group of patients.

scholarly journals American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer

2021 ◽  
Vol 5 (4) ◽  
pp. 927-974
Author(s):  
Gary H. Lyman ◽  
Marc Carrier ◽  
Cihan Ay ◽  
Marcello Di Nisio ◽  
Lisa K. Hicks ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Term Treatment ◽  
Medical Patients ◽  
Short Term ◽  
Patients With Cancer ◽  
Long Term Treatment ◽  
Prevention And Treatment ◽  
Ambulatory Patients ◽  
American Society

Background: Venous thromboembolism (VTE) is a common complication among patients with cancer. Patients with cancer and VTE are at a markedly increased risk for morbidity and mortality. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the prevention and treatment of VTE in patients with cancer. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The guideline development process was supported by updated or new systematic evidence reviews. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess evidence and make recommendations. Results: Recommendations address mechanical and pharmacological prophylaxis in hospitalized medical patients with cancer, those undergoing a surgical procedure, and ambulatory patients receiving cancer chemotherapy. The recommendations also address the use of anticoagulation for the initial, short-term, and long-term treatment of VTE in patients with cancer. Conclusions: Strong recommendations include not using thromboprophylaxis in ambulatory patients receiving cancer chemotherapy at low risk of VTE and to use low-molecular-weight heparin (LMWH) for initial treatment of VTE in patients with cancer. Conditional recommendations include using thromboprophylaxis in hospitalized medical patients with cancer, LMWH or fondaparinux for surgical patients with cancer, LMWH or direct oral anticoagulants (DOAC) in ambulatory patients with cancer receiving systemic therapy at high risk of VTE and LMWH or DOAC for initial treatment of VTE, DOAC for the short-term treatment of VTE, and LMWH or DOAC for the long-term treatment of VTE in patients with cancer.

Venous thromboembolism: What pharmacists know? What do they need?

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 212-212
Author(s):  
Jean-Baptiste Rey ◽  
Pierre Kreit ◽  
Jerome Sicard ◽  
Damien Parent ◽  
Nicolas Jovenin ◽  
...  
Keyword(s):  
Case Report ◽  
Venous Thromboembolism ◽  
Community Pharmacists ◽  
Continuous Education ◽  
Patients With Cancer ◽  
Number Of Patients ◽  
Ambulatory Patients ◽  
Multidisciplinary Group ◽  
Specific Competency ◽  
General Organization

212 Background: Venous thromboembolism is frequent in cancer. Low molecular weight heparins (LMWH) are recommended for prevention/treatment of thrombosis in cancer. Community pharmacists are very often faced with patients' questions (dosage, tolerance, treatment duration). The aim of this study was to assess the community pharmacists' knowledge regarding 'thrombosis in cancer'. Methods: A web-questionnaire (built by a multidisciplinary group) was open between October and November 2013 to community pharmacists in Champagne-Ardenne region. Collected data were 1) pharmacy's general organization for cancer patients' management, 2) management of ambulatory patients with 'thrombosis and cancer' and 3) pharmacists' knowledge assessment through a simple case report: after an initial 10-days hospital prescription, what should a patient receive as anticoagulant treatment? Results: 180 (38%) community pharmacists answered the questionnaire. Among those, in 65%, the number of patients with cancer was 6-15/pharmacy. In 70% the number of patients with thrombosis and cancer was 1-10/pharmacy. In 93%, the pharmacists had no specific competency in oncology and/or supportive care. Moreover, 96% were not aware of the existence of national/international recommendations regarding 'thrombosis in cancer'. At last, only 49% gave the correct answer to the case report (LMWH). The most expressed needs were information, continuous education, and information booklets for patients. Conclusions: This regional questionnaire is currently extended to all French regions. Continuous education sessions are being put in place. Another questionnaire will be launched at the end of 2014 to assess education sessions' efficacy.

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