Prophylaxis for DVTPE in Patients with Cancer

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Prophylaxis for DVT/PE in Patients with Cancer

• Daniel Boxer, M.D.
• Mentor Craig Kessler, M.D.
• August 10, 2006

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Background

• The DVT-Free study showed that among 5,451
  patients (inpatient and outpatient) with
  ultrasound-confirmed DVT, 32 had a pre-existing
  diagnosis of cancer.
• Cancer is one of many well-known recognized risk
  factors for VTE including HTN, surgery in past 3
  months, immobility, obesity, smoking, and CHF.

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• Overall, 71 of the 5,451 patients did not
  receive any prophylaxis (including SCDs).
• 2,726 patients had DVT diagnosed as an inpatient.
• Among this group, only 42 received some form of
  prophylaxis in the 30 days before confirmation of
  DVT.

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Why Anticoagulate

• 3 clinical trials showed the statistically
  significant benefits of various pharmacologic
  methods of DVT prophylaxis versus placebo
• MEDENOX (Enoxaparin, 40 mg sq qd)
• PREVENT (Dalteparin, 5000 units, sq qd)
• ARTEMIS (Fondaparinux, 2.5 mg sq qd)

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• It is clear that unless contraindications to
  anticoagulation exists, patients at risk for
  DVT/PE should receive pharmacologic prophylaxis
  (even New York Yankee fans too).
• Yet, as DVT-Free shows, this is not happening.

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My project

• We will be further focusing on the cancer
  patients with known VTE in the DVT-Free registry,
  and other gathered databases, in an attempt to
  answer certain questions.
• What percentage of cancer patients received
  prophylaxis?
• Are there particular patterns as to which cancer
  patients are receiving prophylaxis and which
  cancer patients arent?
• Is there bias among physicians in regards to type
  of cancer?

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• Is there bias among physicians in regards to
  stage of cancer?
• Is there a difference in the prophylaxis pattern
  of cancer patients in the United States vs.
  Europe, and as such the incidence of DVT/PE?
• And, not least importantly, are cancer patients
  dying of their underlying disease, a venous
  thromboembolic event, or another complication?

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• Where we are currently
• Analyzing, data, lots o lots o data.
• Goals
• 1) To better understand the prophylaxis
  patterns for patients with cancer in general, as
  well as specific cancers and/or stages of cancer,
  in both the U.S. and abroad.
• 2) To better ascertain if cancer patients have
  increased morbidity/mortality from VTE because of
  a lack of prophylaxis.
• 3) Attempt to further emphasize the need for
  prophylaxis of DVT/PE in all cancer patients
  unless otherwise contraindicated.