Article Abstract

Thromboprophylaxis in cancer patients in palliative care setting

Authors: Joana Isabel da Silva Lima


Background: The prevalence of venous thromboembolism (VTE) is high in oncologic patients and can lead to a lower quality of life or result in a fatal event. There are no guidelines for the use of thromboprophylaxis in these patients under palliative care and its use is controversial. In one side there is the prevention of symptoms and death, and in the other side iatrogeny, discomfort and prolongation of life.
Methods: Retrospective, unicenter, descriptive study, based on medical records of hospitalizations during
6 months at the Palliative Care Unit of Instituto Português de Oncologia do Porto.
Results: Five hundred and six hospitalizations were enrolled in the study. The mean age of patients was 67.2 years (SD ±12.7) and 48% were women. More than a third of patients (37%) were admitted at the Palliative Care Unit in the terminal phase of their disease. Previously, 13.8% of the patients were on thromboprophylaxis. At the Palliative Care Unit 6.7% of the patients received prophylactic anticoagulation. Considering the population of terminal patients, 15% received anticoagulation: 9% in therapeutic dosage and 6% in prophylactic dosage. Half of them suspended anticoagulation. The anticoagulant most frequently used was low molecular weight heparin. The incidence of VTE was 1% (0.6% with imaging confirmation) and in 0.2% of the cases VTE was associated with inpatient mortality.
Conclusions: Thromboprophylaxis is not routinely used in this Palliative Care Unit. Still, some terminal patients received prophylactic anticoagulation. The incidence of VTE in this population was quite low and it doesn’t seem to have an important impact on inpatient mortality. Given the absence of guidelines about the use of thromboprophylaxis in the palliative care setting, it should be a shared decision with the patient and his family. The establishment of evidence-based guidelines for thromboprophylaxis in oncologic patients under palliative care is imperative.