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Thromb Haemost 2013; 110(01): 184-190
DOI: 10.1160/TH13-02-0131
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

High incidence of venous thromboembolism despite electronic alerts for thromboprophylaxis in hospitalised cancer patients

Ramón Lecumberri
1   Hematology Service, University Clinic of Navarra, Pamplona, Spain
,
Margarita Marqués
2   Documentation Service, University Clinic of Navarra, Pamplona, Spain
,
Elena Panizo
1   Hematology Service, University Clinic of Navarra, Pamplona, Spain
,
Ana Alfonso
1   Hematology Service, University Clinic of Navarra, Pamplona, Spain
,
Alberto García-Mouriz
3   Informatics Service, University Clinic of Navarra, Pamplona, Spain
,
Ignacio Gil-Bazo
4   Oncology Department, University Clinic of Navarra, Pamplona, Spain
,
José Hermida
5   Division of Cardiovascular Sciences, Centre of Applied Medical Research, University of Navarra, Pamplona, Spain
,
Sam Schulman
6   Department of Medicine, McMaster University, Hamilton, Ontario, Canada
,
José A. Páramo
1   Hematology Service, University Clinic of Navarra, Pamplona, Spain
› Author Affiliations Financial support: This work was partially funded by a grant from the Instituto de Salud Carlos III (Spain) para la evaluación de tecnologías sanitarias (PI05/900094).
Further Information

Publication History

Received: 15 February 2013

Accepted after major revision: 04 April 2013

Publication Date:
30 November 2017 (online)

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Summary

Many cancer patients are at high risk of venous thromboembolism (VTE) during hospitalisation; nevertheless, thromboprophylaxis is frequently underused. Electronic alerts (e-alerts) have been associated with improvement in thromboprophylaxis use and a reduction of the incidence of VTE, both during hospitalisation and after discharge, particularly in the medical setting. However, there are no data regarding the benefit of this tool in cancer patients. Our aim was to evaluate the impact of a computer-alert system for VTE prevention in patients with cancer, particularly in those admitted to the Oncology/Haematology ward, comparing the results with the rest of inpatients at a university teaching hospital. The study included 32,167 adult patients hospitalised during the first semesters of years 2006 to 2010, 9,265 (28.8%) with an active malignancy. Appropriate prophylaxis in medical patients, significantly increased over time (from 40% in 2006 to 57% in 2010) and was maintained over 80% in surgical patients. However, while e-alerts were associated with a reduction of the incidence of VTE during hospitalisation in patients without cancer (odds ratio [OR] 0.31; 95% confidence interval [CI], 0.15–0.64), the impact was modest in cancer patients (OR 0.89; 95% CI, 0.42–1.86) and no benefit was observed in patients admitted to the Oncology/Haematology Departments (OR 1.11; 95% CI, 0.45–2.73). Interestingly, 60% of VTE episodes in cancer patients during recent years developed despite appropriate prophylaxis. Contrary to the impact on hospitalised patients without cancer, implementation of e-alerts for VTE risk did not prevent VTE effectively among those with malignancies.

Keywords

Venous thromboembolism - cancer - hospitalised patients - electronic alerts - prophylaxis
 

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