Cancer is a pro-thrombotic condition and the rate of Venous Thrombosis increased in cancer patients. Low Molecular Weight Heparin (LMWH) molecules is standard of care in Australia. Our aim is to review patterns of clinical presentation and management of venous thrombosis during cancer treatment at Lyell McEwin Hospital over a 3 year period.
Medical Oncology database was used to identify patients with diagnosis of venous thrombosis during cancer treatment between 2011-13. Clinical data and prescription data was collected retrospectively from case notes review.
70 patients were identified with venous thrombosis over the 3 year period. 27 patients were excluded due to insufficient information in the case notes including lack of confirmatory imaging or prescription details. Total 43 patients were included in the study. Venous thrombosis was diagnosed following symptomatic presentation in 28 patients (65%) and 15 (35%) patients having venous thrombosis as an incidental finding on routine imaging. There were 22 (51%) patients had PE while 21(49%) patients had DVT. 8(18%) patients had line related DVT. 32 patients were treated for metastatic cancer while 11 patients received adjuvant treatment. Initial anticoagulant prescriptions were; 25 patients (58%) Enoxaparin 1 mg/kg twice daily, 12 patients (28%) Enoxaparin 1.5 mg/kg once daily and 6 patients (14%) Dalteparin once daily.13 patients (52%) who had initially been prescribed Enoxaparin were subsequently changed to Dalteparin.The subcutaneous injections were administered by the patient or relative in 23 cases and 20 patients were treated by “hospital-at-home” services with home visits once or twice a day for administration of subcutaneous injections.
This retrospective study demonstrates venous thrombosis is a common problem in cancer patients; many presents without symptoms.It also revealed significant variability in anticoagulation therapy in cancer patients at one cancer centre. Dalteparin may have an advantage over Enoxaparin in terms of patient's quality of life through once daily injections instead of twice daily and Health Service costs with nurse visits once daily as compared to twice daily.
Clinical trial identification
R. Joshi: advisory board and honorarium from Pfizer. All other authors have declared no conflicts of interest.