Cancer associated thrombosis with primary prophylaxis in a tertiary hospital in the Philippines from 2010-2015

Abstract

Background: Venous thromboembolism, consisting of pulmonary embolism or peripheral venous thrombosis is the second most common leading cause of death in cancer. Prophylactic measures are now being done to prevent its occurrence. In an financially-challenged patient does primary prophylaxis really protect our patients? Methods: Data from the hospital's database for year 2010-2015 with either Venous Dupplex Scan or Computed Tomographic Pulmonary Angiography (CTPA). Each result were reviewed for presence of acute pulmonary embolism or acute venous thrombosis. Only the first event after the diagnosis of cancer was considered therefore, all subsequent events were ignored. Among those with positive venous thromboembolism results, review of chart and computerized data systemon histologic diagnosis of carcinoma. Results: A total of 10,380 CTPA/Venous duplex scan were performed for year 2010- 2015, where 916 (8.8%) had positive venous thromboembolism (VTE). Of patients with VTE, 712(6.8%) were not associated with malignancy, 204(2%) had malignancy. Average age of patient 61.3(range 19-90), mostly female (61.7%) and had normal body mass index (62.2%). Most common symptom was swelling of the extremity(54%) followed by pain(32%) and dyspnea (12.6%). Lower extremity (77.4%) thrombosis was more common than upper extremity thrombosis (9.8%). Breast cancer (n=37, 18.9%) had the most number of VTE, followed by lung (n=31, 15%). Gynecologic malignancies had up to 21.5%, followed by gastrointestinal malignancies 21.5% (n=44). Most patients had prior hospitalization (n=146, 71.5%) within the past three months prior to the diagnosis of VTE. Up to 81.8% (n=167) had no VTE prophylaxis while 9.8% (n=20) had primary prophylaxis prior to the occurrence of VTE. However, among those who had prophylaxis with heparin, two had no prior hospitalization for three months prior to the VTE diagnosis, and mostly had gynecologic malignancy, breast cancer, and hepatocellular cancer. Seventy percent of them had normal BMI and were mostly <65 years of age. Conclusions: Cancer patients still develop VTE even with primary prophylaxis and no hospitalization for the past three months which were the leading risk factors for developing VTE in prior studies. There is no difference in patient profile for those who received primary prophylaxis in our center compared to the general profile.