The University of Texas MD Anderson Cancer Center, Houston, TX
Maria Alma Rodriguez , Alma Yvette DeJesus , Lee Cheng , Michael Kroll
Background: VTE prophylaxis measures are endorsed by the National Quality Forum in alignment with quality indicators from the Centers for Medicare and Medicaid Services. Accordingly, documentation of VTE risk, prophylaxis measures, and contraindications are recommended for hospitalized patients. To standardize practice we embedded a VTE risk assessment and prophylaxis module into admission and post-surgical order sets (OS), starting August 15, 2011. Methods: A retrospective study of 9,065 cancer patients (≥18 years) admitted to The University of Texas MD Anderson Cancer Center between June 01, 2013, through September 30, 2013. Pharmacological prophylaxis was executed with low-molecular-weight heparin or unfractionated heparin. Mechanical prophylaxis was executed with graduated compression stockings and/or sequential compression devices. Chi-square testing was used to determine the association between categorical variables. Results: 7,366 (81%) of all hospital admissions had documented VTE risk assessment and prophylaxis through the standardized VTE module. Before implementation of the new OS, only 40% of eligible patients received an order for VTE prophylaxis. The majority of patients were designated high or moderate risk (91.1%). Patients with high risk were more likely to receive pharmacological prophylaxis than those with moderate risk (74.1% vs. 38.2%, P<0.01). The most frequent contraindications to pharmacological prophylaxis were major surgery with risk of bleeding and thrombocytopenia. Results are shown in Table. Conclusions: Most patients received VTE prophylaxis based on VTE risk levels presented in a standardized OS. Because there is limited information in the clinical literature about the impact of VTE prophylaxis on outcomes among cancer patients, we plan to monitor and analyze anticoagulation-related outcomes as well as mortality and morbidity related to thrombosis and bleeding in this cohort of patients.
VTE risk level | No (%) | % of prophylaxis | ||
---|---|---|---|---|
Pharmacological | Pharmacological contraindication |
Mechanical | ||
High | 1,021 (13.9%) | 74.1 | 20.1 | 99.7 |
Moderate | 5,689 (77.2%) | 38.2 | 56.3 | 35.4 |
Low | 656 ( 8.9%) | N/A | N/A | 97.6 |
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Abstract Disclosures
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