Assessment of Deep Vein Thrombosis (DVT) incidence among ambulatory cancer patients in Qatar: A retrospective cohort study

Authors

  • Rehab Abdelwahab Pharmacy Department, National Center for Cancer Care & Research, Doha, Qatar
  • Anas Hamad Pharmacy Department, National Center for Cancer Care & Research, Doha, Qatar
  • Reham Negm Oncology Hematology Department, National Center for Cancer Care & Research, Doha, Qatar
  • Nayel Al Tarawneh Quality and Patient Safety Department, National Center for Cancer Care & Research, Doha, Qatar
  • Shereen Elazzazy Pharmacy Department, National Center for Cancer Care & Research, Doha, Qatar

DOI:

https://doi.org/10.30574/gscbps.2021.16.3.0261

Keywords:

VTE, DVT, Ambulatory care, Cancer, Chemotherapy, Prophylaxis

Abstract

Background: Thromboprophylaxis of ambulatory cancer patients is considered controversial. However, some guidelines suggest conducting VTE risk assessment using the Khorana risk assessment scoring model. This study aims to assess the incidence of Deep Vein Thrombosis (DVT) and related cancer types, focusing on the incidence of DVT in ambulatory patients actively on chemotherapy, with Khorana risk score (KRS).

Methods: The Doppler ultrasound reports over 12-month period were reviewed. A total of 205 patients were included in the study. Patients with DVT were screened for the relevant biomarkers in KRS model and any other additional risk factors. Furthermore, a comparison between ambulatory patients who developed DVT and those who did not, was carried on determining the KRS association with incidence.

Results: The incidence of DVT in ambulatory cancer patients was higher than the inpatient setting (23% vs. 8%). Breast cancer was the most common malignancy associated with DVT (30%) followed by colon cancer (17%). Chemotherapy increased the incidence of DVT in ambulatory patients (29% vs. 13%). Patients with KRS of ≥2 were more likely to develop DVT (37.5%).

Conclusion: This study highlights the importance of conducting a thorough DVT risk assessment for ambulatory cancer patients on chemotherapy and the need to look for KRS to reconsider additional risk factors.

Metrics

Metrics Loading ...

References

R Ruth McCaffrey, Cindy Blum. Venothrombotic Events: Evidence-based Risk Assessment, Prophylaxis, Diagnosis, and Treatment. Journal for Nurse Practitioners. 2009; 5(5): 325-333.

Alisa S Wolberg, Maria M Aleman, Karin Leiderman, Kellie R Machlus. Procoagulant Activity in Hemostasis and Thrombosis: Virchow’s Triad Revisited. Anesth Analg. 2012; 114(2): 275–285.

Andra H James. Venous Thromboembolism: Mechanisms, Treatment, and Public. Arterioscler Thromb Vasc Biol. 2009; 29(3): 398-310.

Micheal B Streiff, Bjorn Holmstorm, Dana Angelini, et al. Cancer Associated Venous Thromboembolic Disease, NCCCN Guidelines. 2015.

Tarek Sousou, Alok A Khorana, James P Venous. Thromboembolism: Mechanisms, Treatment, and Public Awareness New Insights Into Cancer-Associated Thrombosis. Arteriosclerosis, Thrombosis, and Vascular Biology. 2009; 29: 316-320.

E Donnellan, B Kevane BR Healey, F Ni Ainle. Cancer and venous thromboembolic disease: from molecular mechanisms to clinical management. Curr Oncol. 2014; 21(3): 134–143.

Jeanet W Blom, Carine JM Doggen, Susanne Osanto, Frits R Rosendaal. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. Journal of American Medical Association. 2005; 293(6): 715-722.

AA Khorana, James P. Cancer and Thrombosis: Implications of Published Guidelines for Clinical Practice. Annals of Oncology. 2009; 20(10): 1619-1630.

Heit JA, O'Fallon WM, Petterson TM, Lohse CM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. JAMA Internal Medicine. 2002; 162(11): 1245-1248.

Khorana AA, Francis CW, Culakova E, Kuderer NM, et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. Journal of Thrombosis and Haemostasis. 2007; 5(3): 632–634.

Agnelli G, Bolis G, Capussotti L, Scarpa RM, et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Annals of Surgery. 2006; 243(1): 89-95.

Helen K Chew, Theodore Wun, Danielle Harvey, Hong Zhou, et al. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. JAMA Internal Medicine. 2006; 166(4): 458-464.

Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. The New England Journal of Medicine. 2000; 343(25): 1846-1850.

Khorana AA, Streiff MB, Farge D, Mandala M, et al. Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action. Journal of Clinical Oncology. 2009; 27(29): 4919-4926.

Clive Kearon, Anthony J. Comerota, Paolo Prandoni, et al. Antithrombotic Therapy and Prevention of Thrombosis,9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2012.

Gary H Lyman, Kari Bohlke, Alok A Khorana, Nicole M Kuderer, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014, version 2015.

Alok A Khorana, Nicole M Kuderer, Eva Culakova et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood Journal. 2008; 111(10): 4902-4907.

Khorana AA, Francis CW, Culakova E, Lyman GH. Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study, Cancer. 2005; 104(12): 2822-2829.

Haddad TC, Greeno EW. Chemotherapy-induced thrombosis. Thrombosis Research. 2006; 118(5): 555-568.

Otten HM, Mathijssen J, ten Cate H, Soesan M, et al. Symptomatic venous thromboembolism in cancer patients treated with chemotherapy: an underestimated phenomenon. JAMA Internal Medicine. 2004; 164(2): 190-194.

Khorana AA, Dalal M, Lin J, Connolly GC. Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United States. Cancer. 2012; 119(3): 648–655.

Agnelli G, Gussoni G, Bianchini C, Verso M, et al. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomized, placebo-controlled, double-blind study. Lancet Oncology. 2009; 10(10): 943–949.

S Elazzazy, R Abd El Wahab, R Negm, MA/Wahid, et al. Clinical Outcomes of Implementing Evidence-Based Practice on Venous Thromboembolism Prevention for Cancer Patients in Qatar, A Retrospective Study. Journal of Clinical Therapeutics. 2015; 37(8): 22–23.

Alok A Khorana, Mehul Dalal, Krishna Tangirala, Raymond Miao. Higher Incidence of Venous Thromboembolism in the Outpatient Versus the Inpatient Setting Among U.S. Cancer Patients. Blood Journal. 2011; 118(21): 674.

Blom JW, Vanderschoot JP, Oostindiër MJ, Osanto S, et al. Incidence of venous thrombosis in a large cohort of 66 329 cancer patients: results of a record linkage study. J Thromb Haemost. 2006; 4(3): 529–535.

Michael B Streiff. Association Between Cancer Types, Cancer Treatments, and Venous Thromboembolism in Medical Oncology Patients. Clinical Advances in Hematology & Oncology. 2013; 11(6): 349-357.

MA Shah, M Capanu, G Soff, T Asmis, et al. Risk factors for developing a new venous thromboembolism in ambulatory patients with non-hematologic malignancies and impact on survival for gastroesophageal malignancies. Journal of Thrombosis and Haemostasis. 2010; 8(8): 1702–1709.

Khorana AA, Francis CW, Culakova E, Kuderer NM, et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. Journal of Thrombosis and Haemostasis. 2007; 5(3): 632–634.

Paneesha S, McManus A, Arya R, Scriven N, et al. Frequency, demographics and risk (according to tumour type or site) of cancer-associated thrombosis among patients seen at outpatient DVT clinics. Thrombosis and Haemostasis. 2009; 103(2): 338–343.

Lustig DB, Rodriguez R, Wells PS. Implementation and validation of a risk stratification method at The Ottawa Hospital to guide thromboprophylaxis in ambulatory cancer Patients at intermediate-high risk for venous thrombosis. Thrombosis Research. 2015; 36(6): 1099–1102.

Khorana AA, Francis CW, Culakova E, Kuderer NM, et al. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer. 2007; 110(10): 2339-2346.

Downloads

Published

2021-09-30

How to Cite

Abdelwahab, R. ., Hamad, A. ., Negm, R. ., Tarawneh, N. A. ., & Elazzazy, S. . (2021). Assessment of Deep Vein Thrombosis (DVT) incidence among ambulatory cancer patients in Qatar: A retrospective cohort study. GSC Biological and Pharmaceutical Sciences, 16(3), 049–058. https://doi.org/10.30574/gscbps.2021.16.3.0261

Issue

Section

Original Article