Cancer and its treatment are recognized risk factors for VTE. Compliance rate with published VTE prophylaxis guidelines is low. Decision on when to offer prophylaxis for hospitalized cancer patients is difficult to make. This paper describes current clinical practice in offering VTE prophylaxis to hospitalized cancer patients. Prophylaxis rate and rate of VTE will be correlated with the risk level. We prospectively followed all consecutive adult cancer patients admitted to medical units over a 5-month period. Caprini risk assessment model, with some modifications, was utilized to determine risk of VTE. Six hundred and six patients (51% males, median age 52 years, range 18-91) were included. Reasons for admission included infections (25%), chemotherapy (22%) and palliative care (10%). In addition to cancer, the most frequently encountered risk factors for VTE were: Immobilization (35%), age > 60 years (31%) and body mass index > 30 in (20%). Patients were grouped according to their total risk score: low (9%), moderate (44%) and high risk (47%). VTE prophylaxis rate was 55.1% for the whole study group. Following discharge, patients were followed for 60 days. The incidence of VTE was 3.4% in the moderate and 4.2% in the high risk groups, while none in the low risk group developed VTE. Many additional risk factors for VTE are usually encountered in hospitalized cancer patients. Cancer alone may not be an enough reason for VTE prophylaxis. Risk assessment model able to stratify patients into different risk categories will simplify decision making and enhance VTE prophylaxis rate.

No abstract

In our study population, 19.4% of acute exacerbation COPD patients were readmitted within 30 days. Patient factors (such as alcohol abuse and advanced disease) were associated with 30-day readmission.

Cancer patients are at higher risk for venous thromboembolism (VTE). Anticoagulants, when used for prophylaxis, had successfully reduced the incidence of VTE in high risk patients. Nevertheless, many registry studies have shown low compliance rate with published prophylaxis guidelines. From January 2004 through June 2008, hospital database was searched for all discharge diagnoses of cancer with deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Prophylaxis rate for the whole group and for subgroups in relation to recent hospitalization, duration of cancer diagnosis and number of other coexisting risk factors were studied. Two hundred patients were identified; majority (91.8%) had advanced-stage cancer at time of VTE diagnosis. In addition to cancer, many patients had multiple coexisting risk factors for VTE with 137 (68.5%) patients had at least three while 71 (35.5%) had four or more. Overall, 111(55.5%) patients developed lower-extremity DVT while 52 (26%) patients developed PE, other sites accounted for 18%. Majority of the patients (72%) had VTE diagnosed within the first 12 months following cancer diagnosis. Almost three quarters of the patients (73.5%) had not received any antecedent prophylaxis. Prophylaxis rate was 23% among patients with C3 risk factors and 50% among the highest risk group with C5 risk factors. Based on our findings, majority of VTE in cancer patients occurred due to failure to offer prophylaxis, minority were due to prophylaxis failure. Meticulous quality improvement programs should be established to emphasize the importance of implementing more intensive prophylaxis among high-risk cancer patients.

Blood transfusion was used the most for cancer-related anemia, while ESAs were rarely used. The majority of patients with moderate anemia were not treated, including patients on active chemotherapy. Better guidelines addressing anemia management in this subgroup of patients are highly needed.