Original Article

Evaluation of Drug Regimens Used for the Prophylaxis of Thromboembolic Events in a Referral Cancer Center in North of Iran


Background: Venous thromboembolism (VTE) is a major cause of mortality among cancer patients. The aim of this study was to evaluate drug regimens used for the prophylaxis of thromboembolic events in cancer patients.
Methods: A retrospective study was conducted using medical records of patients hospitalized from March 2012 to March 2014 at Cancer Division of A tertiary university-affiliated hospital in North of Iran. The risk factors of patients regarding need of venous thromboembolic (VTE) prophylaxis were recognized and dosage and duration of thromboembolic prophylactic agents were evaluated according to the National Comprehensive Cancer Network (NCCN) 2012 guidelines. Statistical analysis was performed using SPSS v.23.
Results: Of a total of 1160 medical records, VTE prophylaxis regimens of 186 patients were evaluated. In 18(13.1%) and 15(10.9%) of patients, administrations were compatible with NCCN guidelines with respect to the "type of drug" and "dosage", respectively. Only in 7(5.1%) of patients administrations were compatible with respect to the "duration of thromboembolic prophylaxis regimen". Forty patients (21.7%) had relative contraindication for thromboembolic prophylaxis and 7(3.8%) patients had absolute contraindication. In 32(80%) of 40 patients with relative contraindications and only in 1(14.3%) of 7 patients with absolute contraindications, physicians’ orders were compatible with NCCN guidelines.
Conclusion: The rate of concordance of the VTE prophylaxis with recommendations provided by NCCN is very poor. This study emphasizes need of a multidisciplinary action to improve the VTE prophylaxis in cancer patients. 

Kakkar AK, Levine M, Pinedo HM, Wolff R, Wong J. Venous thrombosis in cancer patients: insights from the FRONTLINE survey. Oncologist 2003;8:381-8.

Connolly GC, Khorana AA. Emerging risk stratification approaches to cancer-associated thrombosis: risk factors, biomarkers and a risk score. Thromb Res 2010;125 Suppl 2:S1-7.

Cohen AT, Alikhan R, Arcelus JI, et al. Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients. Thromb Haemost 2005;94:750-9.

Khorana AA, Connolly GC. Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol 2009;27:4839-47.

Heit JA, O'Fallon WM, Petterson TM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002;162:1245-8.

Numico G, Garrone O, Dongiovanni V, et al. Prospective evaluation of major vascular events in patients with nonsmall cell lung carcinoma treated with cisplatin and gemcitabine. Cancer 2005;103:994-9.

Rogers MA, Levine DA, Blumberg N, Flanders SA, Chopra V, Langa KM. Triggers of hospitalization for venous thromboembolism. Circulation 2012;125:2092-9.

Agnelli G, Bolis G, Capussotti L, et al. A Clinical Outcome-Based Prospective Study on Venous Thromboembolism After Cancer Surgery: The @RISTOS Project. Ann Surg 2006;243:89-95.

Khorana AA, Francis CW, Culakova E, Fisher RI, Kuderer NM, Lyman GH. Thromboembolism in hospitalized neutropenic cancer patients. J Clin Oncol 2006;24:484-90.

Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer 2007;110:2339-46.

Blom JW, Vanderschoot JP, Oostindier MJ, Osanto S, van der Meer FJ, Rosendaal FR. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost 2006;4:529-35.

Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003;21:3665-75.

Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902-7.

Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005;293:715-22.

Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ, 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000;160:809-15.

IssueVol 3, No 3-4 (Winter 2015) QRcode
SectionOriginal Article(s)
Cancer Venous Thrombosis Guideline Adherence

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How to Cite
Dehkia S, Kouchaki B, Janbabaei G, Shekarriz R, Ala S, Salehifar E. Evaluation of Drug Regimens Used for the Prophylaxis of Thromboembolic Events in a Referral Cancer Center in North of Iran. J Pharm Care. 2017;3(3-4):61-66.