Universal venous thromboembolism policy is effective but may not adequately protect hospitalized cancer patients with larger BMI
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Routine VTE prophylaxis is recommended for hospitalized patients, but its effectiveness and safety in cancer patients is unclear. By observation, larger patients seemed poorly covered by the prophylaxis policy. The effectiveness and safety of VTE prophylaxis policy in the hospitalized patients, their potential risk factors such as BMI were examined. A retrospective chart review was conducted to determine VTE incidences, risk factors for VTE and major bleeding events between 2007 and 2016 on the solid tumor units (STU). Patients were divided into pre-policy (Pre-2012) or post-policy implementation groups (Post-2012). Descriptive statistics were used to evaluate effectiveness and safety of prophylaxis, while propensity score matching (1:3, VTE:Non-VTE) was used to reduce selection bias. The VTE incidence per patient was 1.30% (57/4392) pre-policy and 0.56% (18/3210) post-policy (p value = 0.0013). After propensity score matching, a reduction (32.3%) of VTE cases was observed after policy implementation (OR = 0.677, p = 0.32). BMI was found to be a significant predictor of VTE (OR = 1.094, 95% CI 1.021–1.172, p = 0.011). Between July 2014 and July 2016, 1.7% (19/1091) patients who received anticoagulants had a documented bleeding event. The policy positively impacted VTE events on the STU. A significant predictor of VTE was BMI and patients with high BMI may pose a risk of breaking through standard VTE prophylaxis dosing. There was no reported major bleeding for patients who developed an VTE event despite receiving prophylaxis in either the pre-policy or post-policy phase of the study, although a low incidence of minor bleeding was documented in the post-phase.
KeywordsAnticoagulants Large BMI Quality improvement Risk factors Venous thromboembolism
Dr. M.K. Krzyzanowska is acknowledged for the review of the manuscript, Jennifer Carter, Nathalie Nguyen, Joseph Samuel, Naoko Sakurai, Andrew Stessman, Helen Thu Vu, Tian, Q. Wang and Maria Zigas are recognized for their help with data abstraction, clinical pharmacists on 17A and 17B in-patient units, the Pharmacy Informatics Department and Decision Support Department at UHN for their assistance with the generation of specified data.
AX participated in data collection and drafted the manuscript. HS participated in data interpretation and edited the manuscript. MKK participated in reviewing the manuscript. EGA participated in study design, statistical analysis, and edited the manuscript. KJ participated in data collection and edited the manuscript. JTS principal investigator and senior author participated in the study design and editing of the manuscript.
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