An observational study of patients with advanced cancer admitted to specialist palliative care units (SPCUs) found that 1 in 3 had deep vein thrombosis and that thromboprophylaxis may have little benefit for late-stage disease. These findings were recently published in The Lancet Haematology.
Prior to this study, the true prevalence of deep vein thrombosis in patients with advanced cancer was unknown. In addition, though thromboprophylaxis is recommended to prevent thromboembolism in the hospital setting, very few studies have determined whether thromboprophylaxis is effective specifically in patients with advanced cancer.
In this prospective, longitudinal, observational study, a cohort of 343 participants admitted to SPCUs were initially evaluated for several clinical characteristics, history of thromboembolism, and previous blood test results. The researchers then screened patients for deep vein thrombosis during disease progression.
The authors reported that the presence of deep vein thrombosis was predicted by a medical history of deep vein thrombosis (P =.011), having been previously bedbound (P =.003), and lower limb edema (P =.009). Importantly, neither the use of thromboprophylactic agents, such as anticoagulants and antithromboembolism stockings, nor serum albumin levels were associated with the presence of deep vein thrombosis.
The results also indicated there was no difference in survival for patients with deep vein thrombosis (mean survival [MS] = 30.55 days, SD = 5.65) compared with patients without deep vein thrombosis (MS = 31.38 days, SD = 6.56; P =.432).
The authors concluded that their findings “[challenged] current recommendations for prevention of venous thromboembolism in advanced cancer” and raised additional questions about the timing and usage of thromboprophylaxis in this patient population.
1. White C, Noble SIR, Watson M, 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 [published online February 1, 2019]. Lancet Haematol. doi: 10.1016/S2352-3026(18)30215-1