Primary Thromboprophylaxis in Hospices: The Association Between Risk of Venous Thromboembolism and Development of Symptoms

ContextVenous 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.ObjectivesTo investigate the relationship between risk of VTE and development of symptoms.MethodsRetrospective 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.ResultsA 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%).ConclusionHospice 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.