Prevention of Venous Thromboembolism in Patients With Cancer in Spain

Introduction

Cancer patients with venous thromboembolism (VTE) have a worse outcome compared with those without cancer.1, 2 Pulmonary embolism (PE) is often initially asymptomatic particularly in patients with cancer, and many cases are fatal within the few first days of symptom onset, allowing minimal time for effective treatment to be administered.3 Reducing the incidence of VTE can lead to reduced numbers of sudden deaths due to PE. However, this requires better recognition of at-risk patients, improved estimates of the magnitude of VTE risk in specific patient subgroups, avoiding exposure of patients to VTE risk factors whenever possible, and more widespread use of safe and effective VTE prophylaxis. Importantly, VTE prophylaxis should be targeted to those patients who will benefit most.

Abstract

BACKGROUND

There is scarce information on the strategies for preventing venous thromboembolism (VTE) in patients with cancer.

PATIENTS AND METHODS

We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) database to retrospectively assess the clinical characteristics, prophylactic details, and 3-month mortality of all Spanish patients with active cancer.

RESULTS

Of 24 382 patients enrolled as of October 2009, 4664 (19%) had active cancer, of whom 736 (16%) had recent surgery, and 909 (19%) had recent immobility for ≥4 days. Of these, 68% of the surgical (95% CI: 65–71) and 29% of the immobilized patients (95% CI: 26–32) had received VTE prophylaxis. The 3-month incidence rate of fatal bleeding, fatal pulmonary embolism (PE), and overall death were: 0.68% (95% CI: 0.25–1.45), 1.36% (95% CI: 0.69–2.41), and 13.7% (95% CI: 11.4–16.4), respectively, in the surgical patients. In VTE patients after immobility for ≥4 days, the incidence rates were: 3.52% (95% CI: 2.46–4.87), 5.06% (95% CI: 3.77–6.64), and 44.4% (95% CI: 41.2–47.7), respectively. In the 3019 patients with no recent surgery or immobilization the incidence rates were: 1.32% (95% CI: 0.96–1.78), 3.05% (2.48–3.71), and 23.0% (95% CI: 21.6–24.5), respectively.

CONCLUSIONS

In RIETE, we found a substantial underuse of VTE prophylaxis in at-risk patients, particularly in cancer patients with immobility ≥4 days. This is important because their 3-month outcome is much worse.

Keywords

venous thromboembolism, cancer, outcome, countries