Thromboprophylaxis in the End-of-Life Cancer Care: The Update
Abstract
:1. Introduction
2. Prevalence of Thromboprophylaxis in Hospices and Palliative Care Units
3. Who Needs TPX?
4. Thromboprophylaxis Agent Selection
5. Current Recommendations
6. Risks and Challenges
7. Conclusions
Funding
Conflicts of Interest
References
- Bick, R.L. Alterations of hemostasis associated with malignancy: Etiology, pathophysiology, diagnosis and management. Semin. Thromb. Hemost. 1978, 5, 1–26. [Google Scholar] [CrossRef] [PubMed]
- Timp, J.F.; Braekkan, S.K.; Versteeg, H.H.; Cannegieter, S.C. Epidemiology of cancer-associated venous thrombosis. Blood 2013, 122, 1712–1723. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wun, T.; White, R.H. Epidemiology of cancer-related venous thromboembolism. Best Pract. Res. Clin. Haematol. 2009, 22, 9–23. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Johnson, M.J.; Sherry, K. How do palliative physicians manage venous thromboembolism? Palliat. Med. 1997, 11, 462–468. [Google Scholar] [CrossRef]
- Soto-Cárdenas, M.J.; Pelayo-García, G.; Rodríguez-Camacho, A.; Segura-Fernández, E.; Mogollo-Galván, A.; Giron-Gonzalez, J.A. Venous thromboembolism in patients with advanced cancer under palliative care: Additional risk factors, primary/secondary prophylaxis and complications observed under normal clinical practice. Palliat. Med. 2008, 22, 965–968. [Google Scholar] [CrossRef]
- White, C.; Noble, S.I.R.; Watson, M.; Swan, F.; Allgar, V.L.; Napier, E.; Nelson, A.; McAuley, J.; Doherty, J.; Lee, B.; et al. Prevalence, symptom burden, and natural history of deep vein thrombosis in people with advanced cancer in specialist palliative care units (HIDDen): A prospective longitudinal observational study. Lancet Haematol. 2019, 6, e79–e88. [Google Scholar] [CrossRef] [Green Version]
- Johnson, M.J.; Sproule, M.W.; Paul, J. The prevalence and associated variables of deep venous thrombosis in patients with advanced cancer. Clin. Oncol. 1999, 11, 105–110. [Google Scholar] [CrossRef]
- Seaman, S.; Nelson, A.; Noble, S. Cancer-associated thrombosis, low-molecular-weight heparin, and the patient experience: A qualitative study. Patient Prefer. Adherence 2014, 8, 453–461. [Google Scholar]
- Clinical Practice Guidelines in Oncology: Cancer-Associated Venous Thromboembolic Disease, v.1.2019. National Comprehensive Cancer Network Web Site. Available online: https://www.nccn.org/professionals/physician_gls/pdf/vte.pdf (accessed on 19 October 2019).
- Cai, R.; Zimmermann, C.; Krzyzanowska, M.; Granton, J.; Hannon, B. Thromboprophylaxis for inpatients with advanced cancer in palliative care settings: A systematic review and narrative synthesis. Palliat. Med. 2019, 33, 486–499. [Google Scholar] [CrossRef]
- Weber, C.; Merminod, T.; Herrmann, F.R.; Zulian, G.B. Prophylactic anti-coagulation in cancer palliative care: A prospective randomised study. Support. Care Cancer 2008, 16, 847–852. [Google Scholar] [CrossRef]
- Teno, J.M.; Plotzke, M.; Gozalo, P.; Mor, V. A national study of live discharges from hospice. J. Palliat. Med. 2014, 17, 1121–1127. [Google Scholar] [CrossRef] [PubMed]
- Bryson, J.; Coe, G.; Swami, N.; Murphy-Kane, P.; Seccareccia, D.; Le, L.W.; Rodin, G.; Zimmermann, C. Administrative outcomes five years after opening an acute palliative care unit at a comprehensive cancer center. J. Palliat. Med. 2010, 13, 559–565. [Google Scholar] [CrossRef] [PubMed]
- Holmes, H.M.; Bain, K.T.; Zalpour, A.; Luo, R.; Bruera, E.; Goodwin, J.S. Predictors of anticoagulation in hospice patients with lung cancer. Cancer 2010, 116, 4817–4824. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Johnson, M.J.; McMillan, B.; Fairhurst, C.; Gabe, R.; Ward, J.; Wiseman, J.; Pollington, B.; Noble, S. Primary thromboprophylaxis in hospices: The association between risk of venous thromboembolism and development of symptoms. J. Pain Symptom Manag. 2014, 48, 56–64. [Google Scholar] [CrossRef]
- Gillon, S.; Noble, S.; Ward, J.; Lodge, K.M.; Nunn, A.; Koon, S.; Johnson, M.J. Primary thromboprophylaxis for hospice inpatients: Who needs it? Palliat. Med. 2011, 25, 701–705. [Google Scholar] [CrossRef]
- Kowalewska, C.A.; Noble, B.N.; Fromme, E.K.; McPherson, M.L.; Grace, K.N.; Furuno, J.P. Prevalence and Clinical Intentions of Antithrombotic Therapy on Discharge to Hospice Care. J. Palliat. Med. 2017, 20, 1225–1230. [Google Scholar] [CrossRef]
- Pautex, S.; Vayne-Bossert, P.; Jamme, S.; Herrmann, F.; Vilarino, R.; Weber, C.; Burkhardt, K. Anatomopathological causes of death in patients with advanced cancer: Association with the use of anticoagulation and antibiotics at the end of life. J. Palliat. Med. 2013, 16, 669–674. [Google Scholar] [CrossRef]
- Tardy, B.; Picard, S.; Guirimand, F.; Chapelle, C.; Danel Delerue, M.; Celarier, T.; Ciais, J.F.; Vassal, P.; Salas, S.; Filbet, M.; et al. Bleeding risk of terminally ill patients hospitalized in palliative care units: The RHESO study. J. Thromb. Haemost. 2017, 15, 420–442. [Google Scholar] [CrossRef]
- Gartner, V.; Kierner, K.A.; Namjesky, A.; Kum-Taucher, B.; Hammerl-Ferrari, B.; Watzke, H.H.; Stabel, C. Thromboprophylaxis in patients receiving inpatient palliative care: A survey of present practice in Austria. Support Care Cancer 2012, 20, 2183–2187. [Google Scholar] [CrossRef]
- Legault, S.; Tierney, S.; Sénécal, I. Evaluation of a thromboprophylaxis quality improvement project in a palliative care unit. J. Pain Symptom Manag. 2011, 41, 503–510. [Google Scholar] [CrossRef]
- Noble, S.I.; Nelson, A.; Finlay, I.G. Factors influencing hospice thromboprophylaxis policy: A qualitative study. Palliat. Med. 2008, 22, 808–813. [Google Scholar] [CrossRef]
- Noble, S.I.; Finlay, I.G. Have palliative care teams’ attitudes toward venous thromboembolism changed? A survey of thromboprophylaxis practice across British specialist palliative care units in the years 2000 and 2005. J. Pain Symptom Manag. 2006, 32, 38–43. [Google Scholar] [CrossRef] [PubMed]
- Kierner, K.A.; Gartner, V.; Schwarz, M.; Watzke, H.H. Use of thromboprophylaxis in palliative care patients: A survey among experts in palliative care, oncology, intensive care, and anticoagulation. Am. J. Hosp. Palliat. Med. 2008, 25, 127–131. [Google Scholar] [CrossRef] [PubMed]
- Khorana, A.A.; Kuderer, N.M.; Culakova, E.; Lyman, G.H.; Francis, C.W. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008, 111, 4902–4907. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mansfield, A.S.; Tafur, A.J.; Wang, C.E.; Kourelis, T.V.; Wysokinska, E.M.; Yang, P. Predictors of active cancer thromboembolic outcomes: Validation of the Khorana score among patients with lung cancer. J. Thromb. Haemost. 2016, 14, 1773–1778. [Google Scholar] [CrossRef] [Green Version]
- Ay, C.; Dunkler, D.; Marosi, C.; Chiriac, A.L.; Vormittag, R.; Simanek, R.; Quehenberger, P.; Zielinski, C.; Pabinger, I. Prediction of venous thromboembolism in cancer patients. Blood 2010, 116, 5377–5382. [Google Scholar] [CrossRef]
- Cella, C.A.; Di Minno, G.; Carlomagno, C.; Arcopinto, M.; Cerbone, A.M.; Matano, E.; Tufano, A.; Lordick, F.; De Simone, B.; Muehlberg, K.S.; et al. Preventing venous thromboembolism in ambulatory cancer patients: The ONKOTEV Study. Oncologist 2017, 22, 601–608. [Google Scholar] [CrossRef] [Green Version]
- Pabinger, I.; van Es, N.; Heinze, G.; Posch, F.; Riedl, J.; Reitter, E.M.; Di Nisio, M.; Cesarman-Maus, G.; Kraaijpoel, N.; Zielinski, C.C.; et al. A clinical prediction model for cancer-associated venous thromboembolism: A development and validation study in two independent prospective cohorts. Lancet Haematol. 2018, 5, e289–e298. [Google Scholar] [CrossRef]
- Ferroni, P.; Zanzotto, F.M.; Scarpato, N.; Riondino, S.; Guadagni, F.; Roselli, M. Validation of a Machine Learning Approach for Venous Thromboembolism Risk Prediction in Oncology. Dis. Markers 2017, 2017. [Google Scholar] [CrossRef] [Green Version]
- Gerotziafas, G.T.; Mahé, I.; Elalamy, I. New orally active anticoagulant agents for the prevention and treatment of venous thromboembolism in cancer patients. Ther. Clin. Risk Manag. 2014, 10, 423–436. [Google Scholar] [CrossRef]
- Kearon, C.; Akl, E.A.; Ornelas, J.; Blaivas, A.; Jimenez, D.; Bounameaux, H.; Huisman, M.; King, C.S.; Morris, T.A.; Sood, N.; et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016, 149, 315–352. [Google Scholar] [CrossRef] [PubMed]
- Farge, D.; Debourdeau, P.; Beckers, M.; Baglin, C.; Bauersachs, R.M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G.T.; Haim, N.; et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J. Thromb. Haemost. 2013, 11, 56–70. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Noble, S.I.; Nelson, A.; Turner, C.; Finlay, I.G. Acceptability of low molecular weight heparin thromboprophylaxis for inpatients receiving palliative care: Qualitative study. BMJ 2006, 332, 577–580. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hutchinson, A.; Rees, S.; Young, A.; Maraveyas, A.; Date, K.; Johnson, M.J. Oral anticoagulation is preferable to injected, but only if it is safe and effective: An interview study of patient and carer experience of oral and injected anticoagulant therapy for cancer-associated thrombosis in the select-d trial. Palliat. Med. 2019, 33, 510–517. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- NICE. Venous Thromboembolism in over 16s: Reducing the Risk of Hospital-Acquired Deep Vein Thrombosis or Pulmonary Embolism; National Institute for Health and Care Excellence (NICE): London, UK, 2018; Available online: https://www.nice.org.uk/guidance/ng89 (accessed on 29 December 2019).
- Rojas-Hernandez, C.M. The role of direct oral anticoagulants in cancer-related venous thromboembolism: A perspective beyond the guidelines. Support. Care Cancer 2018, 26, 711–720. [Google Scholar] [CrossRef]
- Agnelli, G.; Buller, H.R.; Cohen, A.; Gallus, A.S.; Lee, T.C.; Pak, R.; Raskob, G.E.; Weitz, J.I.; Yamabe, T. Oral apixaban for the treatment of venous thromboembolism in cancer patients: Results from the AMPLIFY trial. J. Thromb. Haemost. 2015, 13, 2187–2191. [Google Scholar] [CrossRef]
- Prins, M.H.; Lensing, A.W.; Brighton, T.A.; Lyons, R.M.; Rehm, J.; Trajanovic, M.; Davidson, B.L.; Beyer-Westendorf, J.; Pap, A.F.; Berkowitz, S.D.; et al. Oral rivaroxaban versus enoxaparin with vitamin K antagonist for the treatment of symptomatic venous thromboembolism in patients with cancer (EINSTEIN-DVT and EINSTEIN-PE): A pooled subgroup analysis of two randomised controlled trials. Lancet Haematol. 2014, 1, e37–e46. [Google Scholar] [CrossRef]
- Schulman, S.; Goldhaber, S.Z.; Kearon, C.; Kakkar, A.K.; Schellong, S.; Eriksson, H.; Hantel, S.; Feuring, M.; Kreuzer, J. Treatment with dabigatran or warfarin in patients with venous thromboembolism and cancer. Thromb. Haemost. 2015, 114, 150–157. [Google Scholar]
- Oyakawa, T.; Muraoka, N.; Iida, K.; Kusuhara, M.; Mori, K. Use of direct oral anti-coagulants for the treatment of venous thromboembolism in patients with advanced cancer: A prospective observational study. Int. J. Clin. Oncol. 2019, 24, 876–881. [Google Scholar] [CrossRef]
- Barbarawi, M.; Zayed, Y.; Kheiri, B.; Gakhal, I.; Barbarawi, O.; Bala, A.; Alabdouh, A.; Abdalla, A.; Rizk, F.; Bachuwa, G.; et al. The role of anticoagulation in venous thromboembolism primary prophylaxis in patients with malignancy: A systematic review and meta-analysis of randomized controlled trials. Thromb. Res. 2019, 181, 36–45. [Google Scholar] [CrossRef]
- Zabrocka, E.; Wojtukiewicz, M.Z.; Sierko, E. Thromboprophylaxis in cancer patients in hospice. Adv. Clin. Exp. Med. 2018, 27, 283–289. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Geerts, W.H.; Bergqvist, D.; Pineo, G.F.; Heit, J.A.; Samama, C.M.; Lassen, M.R.; Colwell, C.W. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008, 133, 381S–453S. [Google Scholar] [CrossRef] [PubMed]
- Key, N.S.; Khorana, A.A.; Kuderer, N.M.; Bohlke, K.; Lee, A.Y.Y.; Arcelus, J.I.; Wong, S.L.; Balaban, E.P.; Flowers, C.R.; Francis, C.W.; et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J. Clin. Oncol. 2020, 38, 496–520. [Google Scholar] [CrossRef] [PubMed]
- Mandalà, M.; Falanga, A.; Roila, F. Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann. Oncol. 2011, 22, 85–92. [Google Scholar] [CrossRef]
- Farge, D.; Frere, C.; Connors, J.M.; Ay, C.; Khorana, A.A.; Munoz, A.; Brenner, B.; Kakkar, A.; Rafii, H.; Solymoss, S.; et al. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2019, 20, e566–e581. [Google Scholar] [CrossRef] [Green Version]
- Monreal, M.; Falga, C.; Valdes, M.; Suarez, C.; Gabriel, F.; Tolosa, C.; Montes, J. Fatal pulmonary embolism and fatal bleeding in cancer patients with venous thromboembolism: Findings from the RIETE registry. J. Thromb. Haemost. 2006, 4, 1950–1956. [Google Scholar] [CrossRef]
- Chambers, J.C. Prophylactic heparin in palliative care: ...to a challenging idea. BMJ 2006, 332, 729. [Google Scholar] [CrossRef] [Green Version]
Authors | Thromboprophylaxis (TPX) Prevalence % (Number of Patients Receiving TPX/all Patients) | Type of TPX (Primary/Secondary) | % of Cancer Patients in the Study Group | Setting |
---|---|---|---|---|
Holmes et al. [14] | 9 (1557/16,896) | No data | 100 | Hospice |
Johnson et al. [15] | 6 (68/1164) | Primary | 82 | Hospice |
Gillon et al. [16] | 3.7 (13/350) | Primary | 77 | Hospice |
Kowalewska et al. [17] | 4.6 (31/674) | Primary and secondary | 100 | Hospice |
Pautex et al. [18] | 43 (103/240) | No data | 100 | PCU |
Tardy et al. [19] | 44 (527/1199) | Primary | 91 | PCU |
Gartner et al. [20] | 49 (56/115) | Primary and secondary | 100 | PCU |
Legault et al. [21] | 44 (56/127) | Primary | 92 | PCU |
Recommendation | Author | References |
---|---|---|
Thromboprophylaxis (TPX) should be considered for patients receiving palliative care; however, factors, including temporary increases in thrombotic risk factors, bleeding risk, estimated life expectancy, and the views of the patient and their family/carers, should be taken into account. TPX should not be offered to patients in the last days of life. TPX should be reviewed daily. | National Institute for Health and Clinical Excellence (NICE) | [36] |
No guidelines on TPX in palliative care. | American College of Chest Physicians (ACCP) | [32] |
No guidelines on TPX in palliative care. Before implementing VTE prophylaxis in all patients, factors to consider include lack of palliative benefits or any unreasonable burden of TPX. | National Comprehensive Cancer Network (NCCN) | [9] |
No guidelines on TPX in palliative care. | American Society of Clinical Oncology (ASCO) | [45] |
No guidelines on TPX in the hospice setting. Secondary TPX should be discussed with patients receiving palliative chemotherapy. | European Society for Medical Oncology (ESMO) | [46] |
No guidelines on TPX in palliative care. | International clinical practice guidelines | [47] |
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Zabrocka, E.; Sierko, E. Thromboprophylaxis in the End-of-Life Cancer Care: The Update. Cancers 2020, 12, 600. https://doi.org/10.3390/cancers12030600
Zabrocka E, Sierko E. Thromboprophylaxis in the End-of-Life Cancer Care: The Update. Cancers. 2020; 12(3):600. https://doi.org/10.3390/cancers12030600
Chicago/Turabian StyleZabrocka, Ewa, and Ewa Sierko. 2020. "Thromboprophylaxis in the End-of-Life Cancer Care: The Update" Cancers 12, no. 3: 600. https://doi.org/10.3390/cancers12030600