Evaluation of a predictive thrombotic risk and thromboprophylaxis score
in cancer patients in a third level hospital.
Abstract
Introduction: We aimed to analyse the application of Khorana score in
cancer patients. We also tried to evaluate the prescription of primary
thromboprophylaxis in cancer patients at risk of venous thromboembolic
disease (VTE). Methods: A retrospective observational study on survival
of hospitalized patients diagnosed with pulmonary embolism (PE) at the
Hospital Central de la Defensa from January 2009 to March 2018. They
were stratified into tumour PE (TPE) and non-tumour PE (nTPE). A
case-control study was also carried out with TPE patients and non PE
cancer patients (nPEC). Results: 108 patients were diagnosed with TPE,
260 nTPE and 324 nPEC. Gynaecological tumours were the most frequent
(23.1%), followed by lung, digestive and urological cancer (20.4%
each) in TPE group. Death risk was 1,9 times higher in cancer patients
(95%CI: 1.23-2.8) (p <0.001). Khorana score was ≥3 points in
9.7% of TPE and 3.1% of nPEC compared to 26.2% of TPE and 9.9% of
nPEC with Khorana score ≥2 points (p<0.001). 7.4% of TPE
patients received thromboprophylaxis. Khorana score in TPE patients
without thromboprophylaxis was ≥3 points in the 9% and ≥2 points in the
24%. Conclusions: There is a trend towards underuse of
thromboprophylaxis in our cancer patients and mainly in those with high
risk of VTE, as well as poor adherence to the Khorana score. More
studies are needed to validate these findings and to optimize predictive
strategies in the management of these patients.