Journal of Thrombosis and Thrombolysis

, Volume 31, Issue 1, pp 107–112

Venous thromboembolism (VTE) in hospitalized cancer patients: prophylaxis failure or failure to prophylax!

  • Hikmat Abdel-Razeq
  • Faisal Albadainah
  • Shadi Hijjawi
  • Asem Mansour
  • Imad Treish


Cancer patients are at higher risk for venous thromboembolism (VTE). Anticoagulants, when used for prophylaxis, had successfully reduced the incidence of VTE in high risk patients. Nevertheless, many registry studies have shown low compliance rate with published prophylaxis guidelines. From January 2004 through June 2008, hospital database was searched for all discharge diagnoses of cancer with deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Prophylaxis rate for the whole group and for subgroups in relation to recent hospitalization, duration of cancer diagnosis and number of other coexisting risk factors were studied. Two hundred patients were identified; majority (91.8%) had advanced-stage cancer at time of VTE diagnosis. In addition to cancer, many patients had multiple coexisting risk factors for VTE with 137 (68.5%) patients had at least three while 71 (35.5%) had four or more. Overall, 111(55.5%) patients developed lower-extremity DVT while 52 (26%) patients developed PE, other sites accounted for 18%. Majority of the patients (72%) had VTE diagnosed within the first 12 months following cancer diagnosis. Almost three quarters of the patients (73.5%) had not received any antecedent prophylaxis. Prophylaxis rate was 23% among patients with ≥3 risk factors and 50% among the highest risk group with ≥5 risk factors. Based on our findings, majority of VTE in cancer patients occurred due to failure to offer prophylaxis, minority were due to prophylaxis failure. Meticulous quality improvement programs should be established to emphasize the importance of implementing more intensive prophylaxis among high-risk cancer patients.


Cancer Heparin Low molecular weight heparin Thromboembolism 


  1. 1.
    Kniffin WD, Baron JA, Barret J et al (1994) The epidemiology of pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 154:861–866CrossRefPubMedGoogle Scholar
  2. 2.
    Belch JJ, Lowe GDO, Ward AG et al (1981) Prevention of deep vein thrombosis in medical patients by low-dose heparin. Scott Med J 26:115–117PubMedGoogle Scholar
  3. 3.
    Prandoni P, Lensing AW, Cogo A et al (1996) The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 125:1–7PubMedGoogle Scholar
  4. 4.
    Carson JL, Kelley MA, Duff A et al (1992) The clinical course of pulmonary embolism. N Engl J Med 326:1240–1245CrossRefPubMedGoogle Scholar
  5. 5.
    Pengo V, Lensing AW, Prins MH et al (2004) Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 350:2257–2264CrossRefPubMedGoogle Scholar
  6. 6.
    Sørensen HT, Mellemkj’r L, Olsen JH et al (2000) Prognosis of cancers associated with venous thromboembolism. N Engl J Med 343:1846–1850CrossRefPubMedGoogle Scholar
  7. 7.
    Heit JA, Silverstein MD, Mohr DN et al (2000) Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case–control study. Arch Intern Med 160:809–815CrossRefPubMedGoogle Scholar
  8. 8.
    Heit JA, O’Fallon WM, Petterson TM et al (2002) Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 162:1245–1248CrossRefPubMedGoogle Scholar
  9. 9.
    Thodiyil PA, Kakkar AK (2002) Variation in relative risk of venous thromboembolism in different cancers. Thromb Haemost 87:1076–1077PubMedGoogle Scholar
  10. 10.
    Kahn SR, Panju A, Geerts W et al (2007) CURVE study investigators. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 119:145–155CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen AT, Tapson VF, Bergmann JF et al (2008) ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371:387–394CrossRefPubMedGoogle Scholar
  12. 12.
    Tapson VF, Decousus H, Pini M, IMPROVE Investigators et al (2007) Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest 2132:936–945CrossRefGoogle Scholar
  13. 13.
    Goldhaber SZ, Dunn K, MacDougall RC (2000) New onset of venous thromboembolism among hospitalized patients at Brigham and Women’s Hospital is caused more often by prophylaxis failure than by withholding treatment. Chest 118:1680–1684CrossRefPubMedGoogle Scholar
  14. 14.
    Geerts W, Bergqvist D, Pineo G et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133:381–453CrossRefGoogle Scholar
  15. 15.
    Wagman LD, Baird MF, Bennett CL, Bockenstedt PL, Cataland SR, Fanikos J, Fogarty PF, Goldhaber SZ, Grover TS, Haire W, Hassoun H, Hutchinson S, Jahanzeb M, Lee J, Linenberger ML, Millenson MM, Ortel TL, Salem R, Smith JL, Streiff MB, Vedantham S, National Comprehensive Cancer Network (2008) Venous thromboembolic disease, NCCN, clinical practice guidelines in oncology. J Natl Compr Canc Netw 6:716–753PubMedGoogle Scholar
  16. 16.
    Khorana AA, Kuderer NM, Culakova E et al (2008) Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 111:4902–4907CrossRefPubMedGoogle Scholar
  17. 17.
    Ay C, Simanek R, Vormittag R et al (2008) High plasma levels of soluble P-selectin are predictive of venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS). Blood 112:2703–2708CrossRefPubMedGoogle Scholar
  18. 18.
    Ay C, Vormittag R, Dunkler D et al (2009) D-dimer and prothrombin fragment 1 + 2 predict venous thromboembolism in patients with cancer: results from the Vienna Cancer and Thrombosis Study (CATS). J Clin Oncol 27:4124–4129CrossRefPubMedGoogle Scholar
  19. 19.
    Abdel-Razeq HN, Hijjawi SB, Jallad SG, Ababneh BA (2010) Venous thromboembolism risk stratification in medically-ill hospitalized cancer patients. A comprehensive cancer center experience. J Thromb Thrombolysis. [Epub ahead of print]Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Hikmat Abdel-Razeq
    • 1
  • Faisal Albadainah
    • 1
  • Shadi Hijjawi
    • 1
  • Asem Mansour
    • 2
  • Imad Treish
    • 3
  1. 1.Division of Hematology and Medical Oncology, Department of Internal MedicineKing Hussein Cancer CenterAmmanJordan
  2. 2.Department of RadiologyKing Hussein Cancer CenterAmmanJordan
  3. 3.Department of PharmacyKing Hussein Cancer CenterAmmanJordan

Personalised recommendations