Practical model for implementation of cancer-associated thrombosis prevention in the outpatient setting

Abstract

IntroductionInternational guidelines recommend assessing venous thromboembolism (VTE) risk and outpatient thromboprophylaxis in selected high risk cancer patients. However, thromboprophylaxis rate in these patients is low in clinical practice. Therefore, we developed a multidisciplinary intervention algorithm to raise awareness about VTE and apply thromboprophylaxis in the outpatient setting. Materials and methodsIn a 12-month period, all single-center cancer patients were evaluated in an initial nursing consultation prior to first systemic therapy start. Consenting patients identified with a Khorana score ≥2 were referred to a specialist consultation in Oncology/Thromboembolic Risk, offering thromboprophylaxis with direct-acting anticoagulant or low molecular weight heparin if without excessive bleeding risk. The corresponding data was recorded in an observational and prospective manner. ResultsA total of 190 patients were evaluated from model implementation, of which 61 patients (32.1 %) had a Khorana score ≥2 (18.9 % with 2; 13.2 % with >2). Of these, 85.2 % consented to specialized assessment. In this group, a median age (med) of 65.5 years was observed [40–92]; the most common tumors were pancreas (26.9 %) and lung (26.9 %). Thromboprophylaxis was offered to 86.5 %; in these there was a non compliance rate of 4.4 %. In a med follow-up period of 116 days after thromboprophylaxis start there was a rate of major bleeding of 2.3 % and VTE of 4.7 %. ConclusionsThis is a feasible model for a generalized VTE risk assessment and subsequent thromboprophylaxis in an outpatient clinic setting. This methodology allows events and survival monitoring and evaluating other clinically relevant outcomes, such as quality of life.