Primary Thromboprophylaxis in Hospices: The Association Between Risk of Venous Thromboembolism and Development of Symptoms
Journal of Pain and Symptom Management
Volume 48, Issue 1 , Pages 56-64, July 2014
Abstract
Context
Venous
thromboembolism (VTE) risk assessment for adults admitted to hospital
is commonplace, but the utility of assessment tools in patients admitted
to hospices or palliative care units and prediction of symptomatic VTE is unknown.
Objectives
To investigate the relationship between risk of VTE and development of symptoms.
Methods
Retrospective
consecutive admission, case-note data from seven U.K. hospices were
collected during an evaluation of a VTE risk assessment protocol using
the Pan Birmingham Cancer Network palliative-modified Thromboembolic
Risk Factors (THRIFT) Consensus Group criteria and presence/absence of a
temporary elevated risk (TER) of VTE. Symptoms/signs during admission
consistent with possible VTE were documented.
Results
A
total of 1164 case-notes were analyzed (age range 23–99; men 627).
THRIFT risk was high in 13%, medium in 83%, and low in 4%; a TER was
identified in 24%. In the “clinically relevant group” (no
contraindication, not anticoagulated), where primary thromboprophylaxis
could have been prescribed (n = 528), TER and symptoms were associated (21% symptoms with TER vs. 9% symptoms without TER: Chi-squared, P < 0.001).
A high/moderate THRIFT score had a sensitivity of 98.4% (95% CI
91.3%–99.9%) and specificity of 5.8% (95% CI 3.9%–8.3%). The TER
assessment had a more evenly balanced sensitivity (41.9%; 95% CI
29.5%–55.2%) and specificity (79%; 95% CI 75.0%–82.6%).
Conclusion
Hospice
inpatients are at risk for VTE.
TER alone is simpler to use and may be
more useful in this population than the THRIFT but still has limitations
regarding ability to predict symptoms.
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