Adherence to treatment guidelines for cancer-associated thrombosis: a French hospital-based cohort study.

Abstract

French 2008 treatment guidelines recommend low-molecular-weight heparins (LMWH) for the treatment of cancer-associated thrombosis (CAT) with treatment duration of at least 3months and up to 6months and beyond if cancer remains active. Our aim was to assess adherence to guidelines in hospital clinical practice. The French hospital database (PMSI) was used to identify patients with CAT admitted to three hospitals of the Paris region to be included in a retrospective cohort study. Adherence to guidelines was assessed in patients included from different treatment periods following the venous thromboembolism (VTE) episode i.e. first 10days (T1), day 10 to 3months (T2), months 3 to 6 (T3) and beyond 6months (T4) when applicable. A total of 240 patients with CAT were included from January 2012 to December 2012 of whom 204 were analyzable. Treatment was adherent to guidelines in 55, 31 and 34% of patients in T1, T2 and T3 treatment periods, respectively, while overall treatment adherence was found in 52% of patients. Adherence rates were the highest among patients with pulmonary embolism (PE, 60.5%), catheter-related thrombosis (62.5%), class III/IV extended cancer (58.0%) and metastatic malignancy (60.3%) while only 40% with deep vein thrombosis (DVT) received a treatment consistent with guidelines. Adherence to guidelines appears insufficient since only half of patients received an appropriate treatment. Adherence dropped significantly across treatment periods T2 and T3. VTE diagnosis and cancer characteristics influenced the anticoagulant prescription. Management of patients with CAT requires further education and information of health care professionals.