eISSN: 1897-4309
ISSN: 1428-2526
Contemporary Oncology/Współczesna Onkologia
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vol. 22
Original paper

The comparison between Caprini and Padua VTE risk assessment models for hospitalised cancer patients undergoing chemotherapy at the tertiary oncology department in Poland: is pharmacological thromboprophylaxis overused?

Robert F. Łukaszuk, Justyna Dolna-Michno, Krzysztof Plens, Grzegorz Czyżewicz, Anetta Undas

Contemp Oncol (Pozn) 2018; 22 (1): 31-36
Online publish date: 2018/04/03
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Aim of the study
Thromboprophylaxis in cancer patients during hospitalization reduces the risk of venous thromboembolism (VTE).

Material and methods
To assess the underuse and the overuse of thromboprophylaxis in cancer patients at a tertiary oncology department, we retrospectively analyzed 1983 consecutive hospitalizations of 498 cancer patients who received chemotherapy from October 2016 to May 2017. The Padua prediction score (≥ 4 points) and Caprini risk assessment (≥ 5 points) were used to identify patients at high risk of VTE.

The majority of individuals (n = 363, 72.9%) suffered from advanced lung cancer. We found that 419 (84.14%) patients received thromboprophylaxis with enoxaparin 40 mg qd, including 181 (43.2%) individuals using concomitant mechanical thromboprophylaxis. As few as 44 (8.8%) and 11 (2.2%) patients did not receive thromboprophylaxis despite high VTE risk based on the Caprini risk assessment and Padua prediction score, respectively (p < 0.001). The number of patients without high risk of VTE, who received pharmacological thromboprophylaxis, was higher when the Padua prediction score was used compared with the Caprini risk assessment (n = 391 [78.5%] vs. n = 210 [42.2%], respectively; p < 0.001). Three patients (0.6%) experienced vascular events during hospital stay, including one symptomatic deep-vein thrombosis. No major bleeding was observed. Predictors of thromboprophylaxis overuse were as follows: previous VTE and abnormal pulmonary function for both scales.

This study shows that thromboprophylaxis in cancer in patients undergoing chemotherapy is suboptimal in Poland in part due to the use of various VTE risk scores yielding discrepant results in everyday practice.


thromboprophylaxis, cancer, hospitalisation, chemotherapy, the overuse of thromboprophylaxis

Steuer C, Behera M, Kim S, et al. Predictors and outcomes of venous thromboembolism in hospitalized lung cancer patients: A Nationwide Inpatient Sample database analysis. Lung Cancer 2015; 88: 80-4.
Cohen AT, Tapson VF, Bergmann JF, et al. ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371: 387-94.
Kahn SR, Lim W, Dunn AS et al. 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: 195-226.
Lindblad B, Sternby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ 1991; 302: 709-11.
Kakkar N, Vasishta RK. Pulmonary embolism in medical patients: an autopsy-based study. Clin Appl Thromb Hemost. 2008; 14: 159-67.
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.
Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ III. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160: 809-15.
Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005; 293: 715-22.
Khorana AA, Connolly GC. Assessing risk of venous thromboembolism in the cancer patient. J Clin Oncol 2009; 27: 4839-47.
Zawilska K, Bała M, Błędowski P, et al. Polish guidelines for the prevention and treatment of venous thromboembolism. 2012 update. Pol Arch Med Wewn 2012; 122: 3-74.
Sallah S, Wan JY, Nguyen NP. Venous thrombosis in patients with solid tumours: determination of frequency and characteristics. Thromb Haemost 2002; 87: 575-9.
Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006; 166: 458-64.
Khorana AA, Francis CW, Culakova E, Lyman GH. Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study. Cancer 2005; 104: 2822-9.
Sorensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000; 343: 1846-50.
Blom JW, Osanto S, Rosendaal FR. The risk of a venous thrombotic event in lung cancer patients: higher risk for adenocarcinoma than squamous cell carcinoma. J Thromb Haemost 2004; 2: 1760-5.
Krasiński Z, Krasińska B, Dzieciuchowicz Ł, Urbanek T, Gabriel M. Heparins in cancer-associated venous thrombosis. Pol Arch Med Wewn 2016; 126: 419-42.
Wojtukiewicz MZ, Sierko E, Tomkowski W, et al. Guidelines for the prevention and treatment of venous thromboembolism in patients with cancers treated conservatively. Oncol Clin Pract 2016; 12: 67-91.
Brierley JD, Gospodarowicz MK, Wittekind C, TNM Classification of Malignant Tumours Eighth edition. Wiley -Blackwell 2016.
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: 452-66.
Łukaszuk R, Plens K, Undas A. Real-life use of thromboprophylaxis in patients hospitalized for pulmonary disorders: a single-center retrospective study Adv Clin Exp Med 2018; 27: 237-43.
Liu X, Liu C, Chen X, Wu W, Lu G. Comparison between Caprini and Padua risk assessment models for hospitalized medical patients at risk for venous thromboembolism: a retrospective study. Interact Cardiovasc Thorac Surg 2016; 23: 538-43.
Zhou HX , Peng LQ, Yan Y, Yi Q, Tang YJ, Shen YC, Feng YL, Wen FQ.
Validation of the Caprini risk assessment model in Chinese hospitalized patients with venous thromboembolism. Thromb Res 2014; 21: 261-72.
Van Es N, Di Nisio M, Cesarman G, et al. Comparison of risk prediction scores for venous thromboembolism in cancer patients: a prospective cohort study. Haematologica 2017; 102: 1494-501.
Verso M, Gussoni G, Agnelli G. Prevention of venous thromboembolism in patients with advanced lung cancer receiving chemotherapy: a combined analysis of the PROTECHT and TOPIC-2 studies. J Thromb Haemost 2010; 8: 1649-51.
Rogers L. Cerebrovascular complications in cancer patients. Neurologic Clinics 2003; 21: 167-92.
Weitz JI, Jaffer IH. Optimizing the safety of treatment for venous thromboembolism in the era of direct oral anticoagulants. Pol Arch Med Wewn 2016; 126: 688-96.
Hosmer Jr DW, Lemeshow S. Applied logistic regression. 2nd ed. John Wiley & Sons, New York 2004; 167.
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