Skip to main content
Erschienen in: Clinical and Translational Oncology 6/2019

16.11.2018 | Brief Research Article

Improvement of appropriate pharmacological prophylaxis in hospitalised cancer patients with a multiscreen e-alert system: a single-centre experience

verfasst von: R. Figueroa, A. Alfonso, J. López-Picazo, I. Gil-Bazo, A. García-Mouriz, J. Hermida, J. A. Páramo, R. Lecumberri

Erschienen in: Clinical and Translational Oncology | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Thromboprophylaxis use among medical inpatients, including cancer patients, is suboptimal. We aimed to evaluate the impact of a novel multiscreen version (v2.0) of an e-alert system for VTE prevention in hospitalised cancer medical patients compared to the original software.

Methods

Prospective study including 989 consecutive adult cancer patients with high-risk of VTE. Patients were followed-up 30 days post-discharge. Two periods were defined, according to the operative software.

Results

E-alert v2.0 was associated with an increase in the use of LMWH prophylaxis (65.5% vs. 72.0%); risk difference (95% CI) 0.064 (0.0043–0.12). Only 16% of patients in whom LMWH prophylaxis was not prescribed lacked a contraindication. No significant differences in the rates of VTE (2.9% vs. 3.2%) and major bleeding (2.7% vs. 4.0%) were observed.

Conclusions

E-alert v2.0 further increased the use of appropriate thromboprophylaxis in hospitalised cancer patients, although was not associated with a reduction in VTE incidence.
Literatur
1.
Zurück zum Zitat Spyropoulos AC, Raskob GE. New paradigms in venous thromboprophylaxis of medically ill patients. Thromb Haemost. 2017;117(9):1662–70.CrossRefPubMed Spyropoulos AC, Raskob GE. New paradigms in venous thromboprophylaxis of medically ill patients. Thromb Haemost. 2017;117(9):1662–70.CrossRefPubMed
2.
Zurück zum Zitat Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer. 2007;110(10):2339–46.CrossRefPubMed Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer. 2007;110(10):2339–46.CrossRefPubMed
3.
Zurück zum Zitat Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B, Marchiori A, Sabbion P, Prins MH, Noventa F, Girolami A. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002;100(10):3484–8.CrossRef Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B, Marchiori A, Sabbion P, Prins MH, Noventa F, Girolami A. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002;100(10):3484–8.CrossRef
4.
Zurück zum Zitat Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712–23.CrossRefPubMed Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712–23.CrossRefPubMed
5.
Zurück zum Zitat Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, Cook DJ, Balekian AA, Klein RC, Le H, Schulman S, Murad MH. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e195S–226S.CrossRefPubMedPubMedCentral Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, Cook DJ, Balekian AA, Klein RC, Le H, Schulman S, Murad MH. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e195S–226S.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Farge D, Bounameaux H, Brenner B, Cajfinger F, Debourdeau P, Khorana AA, Pabinger I, Solymoss S, Douketis J, Kakkar A. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2016;17(10):e452–66.CrossRefPubMed Farge D, Bounameaux H, Brenner B, Cajfinger F, Debourdeau P, Khorana AA, Pabinger I, Solymoss S, Douketis J, Kakkar A. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2016;17(10):e452–66.CrossRefPubMed
7.
Zurück zum Zitat Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, Huang W, Zayaruzny M, Emery L, Anderson FA Jr, ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387–94.CrossRefPubMed Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, Huang W, Zayaruzny M, Emery L, Anderson FA Jr, ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387–94.CrossRefPubMed
8.
Zurück zum Zitat Amin AN, Stemkowski S, Lin J, Yang G. Inpatient thromboprophylaxis use in U.S. hospitals: adherence to the seventh American College of Chest Physician’s recommendations for at-risk medical and surgical patients. J Hosp Med. 2009;4(8):E15–21.CrossRefPubMed Amin AN, Stemkowski S, Lin J, Yang G. Inpatient thromboprophylaxis use in U.S. hospitals: adherence to the seventh American College of Chest Physician’s recommendations for at-risk medical and surgical patients. J Hosp Med. 2009;4(8):E15–21.CrossRefPubMed
9.
Zurück zum Zitat Kucher N, Koo S, Quiroz R, Cooper JM, Paterno MD, Soukonnikov B, Goldhaber SZ. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med. 2005;352(10):969–77.CrossRefPubMed Kucher N, Koo S, Quiroz R, Cooper JM, Paterno MD, Soukonnikov B, Goldhaber SZ. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med. 2005;352(10):969–77.CrossRefPubMed
10.
Zurück zum Zitat Lecumberri R, Marqués M, Díaz-Navarlaz MT, Panizo E, Toledo J, García-Mouriz A, Páramo JA. Maintained effectiveness of an electronic alert system to prevent venous thromboembolism among hospitalized patients. Thromb Haemost. 2008;100(4):699–704.CrossRefPubMed Lecumberri R, Marqués M, Díaz-Navarlaz MT, Panizo E, Toledo J, García-Mouriz A, Páramo JA. Maintained effectiveness of an electronic alert system to prevent venous thromboembolism among hospitalized patients. Thromb Haemost. 2008;100(4):699–704.CrossRefPubMed
11.
Zurück zum Zitat Lecumberri R, Panizo E, Gomez-Guiu A, Varea S, García-Quetglas E, Serrano M, García-Mouriz A, Marqués M, Gómez-Outes A, Páramo JA. Economic impact of an electronic alert system to prevent venous thromboembolism in hospitalised patients. J Thromb Haemost. 2011;9(6):1108–15.CrossRefPubMed Lecumberri R, Panizo E, Gomez-Guiu A, Varea S, García-Quetglas E, Serrano M, García-Mouriz A, Marqués M, Gómez-Outes A, Páramo JA. Economic impact of an electronic alert system to prevent venous thromboembolism in hospitalised patients. J Thromb Haemost. 2011;9(6):1108–15.CrossRefPubMed
12.
Zurück zum Zitat Lecumberri R, Marqués M, Panizo E, Alfonso A, García-Mouriz A, Gil-Bazo I, Hermida J, Schulman S, Páramo JA. High incidence of venous thromboembolism despite electronic alerts for thromboprophylaxis in hospitalised cancer patients. Thromb Haemost. 2013;110(1):184–90.PubMed Lecumberri R, Marqués M, Panizo E, Alfonso A, García-Mouriz A, Gil-Bazo I, Hermida J, Schulman S, Páramo JA. High incidence of venous thromboembolism despite electronic alerts for thromboprophylaxis in hospitalised cancer patients. Thromb Haemost. 2013;110(1):184–90.PubMed
13.
Zurück zum Zitat Nieto JA, Cámara T, Camacho I, MEDITROM Investigators. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients. A retrospective multicenter study. Eur J Intern Med. 2014;25(8):717–23.CrossRefPubMed Nieto JA, Cámara T, Camacho I, MEDITROM Investigators. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients. A retrospective multicenter study. Eur J Intern Med. 2014;25(8):717–23.CrossRefPubMed
14.
Zurück zum Zitat Schulman S, Kearon C. Subcommittee on control of anticoagulation of the scientific and standardization committee of the international society on thrombosis and haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692–4.CrossRef Schulman S, Kearon C. Subcommittee on control of anticoagulation of the scientific and standardization committee of the international society on thrombosis and haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692–4.CrossRef
15.
Zurück zum Zitat Zwicker JI, Rojan A, Campigotto F, Rehman N, Funches R, Connolly G, Webster J, Aggarwal A, Mobarek D, Faselis C, Neuberg D, Rickles FR, Wun T, Streiff MB, Khorana AA. Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers: a prospective, cross-sectional, multicenter study. J Clin Oncol. 2014;32(17):1792–6.CrossRefPubMedPubMedCentral Zwicker JI, Rojan A, Campigotto F, Rehman N, Funches R, Connolly G, Webster J, Aggarwal A, Mobarek D, Faselis C, Neuberg D, Rickles FR, Wun T, Streiff MB, Khorana AA. Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers: a prospective, cross-sectional, multicenter study. J Clin Oncol. 2014;32(17):1792–6.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Panizo E, Alfonso A, García-Mouriz A, López-Picazo JM, Gil-Bazo I, Hermida J, Páramo JA, Lecumberri R. Factors influencing the use of thromboprophylaxis in cancer outpatients in clinical practice: a prospective study. Thromb Res. 2015;136(6):1145–8.CrossRefPubMed Panizo E, Alfonso A, García-Mouriz A, López-Picazo JM, Gil-Bazo I, Hermida J, Páramo JA, Lecumberri R. Factors influencing the use of thromboprophylaxis in cancer outpatients in clinical practice: a prospective study. Thromb Res. 2015;136(6):1145–8.CrossRefPubMed
17.
Zurück zum Zitat Flanders SA, Greene MT, Grant P, Kaatz S, Paje D, Lee B, Barron J, Chopra V, Share D, Bernstein SJ. Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism: a cohort study. JAMA Intern Med. 2014;174(10):1577–84.CrossRefPubMed Flanders SA, Greene MT, Grant P, Kaatz S, Paje D, Lee B, Barron J, Chopra V, Share D, Bernstein SJ. Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism: a cohort study. JAMA Intern Med. 2014;174(10):1577–84.CrossRefPubMed
18.
Zurück zum Zitat Kucher N, Spirk D, Baumgartner I, Mazzolai L, Korte W, Nobel D, Banyai M, Bounameaux H. Lack of prophylaxis before the onset of acute venous thromboembolism among hospitalized cancer patients: the SWIss Venous ThromboEmbolism Registry (SWIVTER). Ann Oncol. 2010;21(5):931–5.CrossRefPubMed Kucher N, Spirk D, Baumgartner I, Mazzolai L, Korte W, Nobel D, Banyai M, Bounameaux H. Lack of prophylaxis before the onset of acute venous thromboembolism among hospitalized cancer patients: the SWIss Venous ThromboEmbolism Registry (SWIVTER). Ann Oncol. 2010;21(5):931–5.CrossRefPubMed
Metadaten
Titel
Improvement of appropriate pharmacological prophylaxis in hospitalised cancer patients with a multiscreen e-alert system: a single-centre experience
verfasst von
R. Figueroa
A. Alfonso
J. López-Picazo
I. Gil-Bazo
A. García-Mouriz
J. Hermida
J. A. Páramo
R. Lecumberri
Publikationsdatum
16.11.2018
Verlag
Springer International Publishing
Erschienen in
Clinical and Translational Oncology / Ausgabe 6/2019
Print ISSN: 1699-048X
Elektronische ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-018-1986-1

Weitere Artikel der Ausgabe 6/2019

Clinical and Translational Oncology 6/2019 Zur Ausgabe

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.