Annals of Oncology Advance Access published online on October 14, 2009
Annals of Oncology, doi:10.1093/annonc/mdp406
Lack of prophylaxis before the onset of acute venous thromboembolism among hospitalized cancer patients: the SWIss Venous ThromboEmbolism Registry (SWIVTER)
1 Department of Cardiovascular Medicine, University Hospital Zurich, Zurich
2 Medical Department, sanofi-aventis (suisse) sa, Meyrin
3 Department of Cardiovascular Medicine, University Hospital Berne, Berne
4 Department of Internal Medicine, University Hospital Lausanne, Lausanne
5 Department of Internal Medicine, Cantonal Hospital St Gallen, St Gallen
6 Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne
7 Department of Internal Medicine, University Hospital Geneva, Geneva, Switzerland
* Correspondence to: Dr N. Kucher, Venous Thromboembolism Consult Service, Department of Cardiovascular Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Tel: +41-44-255-8762; Fax: +41-44-255-4401; E-mail: kuchernils{at}yahoo.com
Background: Venous thromboembolism (VTE) prophylaxis remains underutilized, particularly in cancer patients. We explored clinical predictors of prophylaxis in hospitalized cancer patients before the onset of acute VTE.
Methods: In the SWiss Venous ThromboEmbolism Registry, 257 cancer patients (61 ± 15 years) with acute VTE and prior hospitalization for acute medical illness or surgery within 30 days (91% were at high risk with Geneva VTE risk score 
3) were enrolled.
Results: Overall, 153 (60%) patients received prophylaxis (49% pharmacological and 21% mechanical) before the onset of acute VTE. Outpatient status at the time of VTE diagnosis [odds ratio (OR) 0.31, 95% confidence interval (CI) 0.18–0.53], ongoing chemotherapy (OR 0.51, 95% CI 0.31–0.85), and recent chemotherapy (OR 0.53, 95% CI 0.32–0.88) were univariately associated with the absence of VTE prophylaxis. In multivariate analysis, intensive care unit admission within 30 days (OR 7.02, 95% CI 2.38–20.64), prior deep vein thrombosis (OR 3.48, 95% CI 2.14–5.64), surgery within 30 days (OR 2.43, 95% CI 1.19–4.99), bed rest >3 days (OR 2.02, 95% CI 1.08–3.78), and outpatient status (OR 0.38, 95% CI 0.19–0.76) remained the only independent predictors of thromboprophylaxis.
Conclusions: Although most hospitalized cancer patients were at high risk, 40% did not receive any prophylaxis before the onset of acute VTE. There is a need to improve thromboprophylaxis in cancer patients, particularly in the presence of recent or ongoing chemotherapy.
cancer, thromboprophylaxis, venous thromboembolism
Received for publication April 24, 2009. Revision received July 14, 2009. Accepted for publication July 15, 2009.