Originally published as JCO Early Release 10.1200/JCO.2009.22.3644 on August 24 2009

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Prevention of Venous Thromboembolism in Hospitalized Patients With Cancer

From the Department of Medicine, University of Rochester, Rochester, NY.

Corresponding author: Charles W. Francis, MD, 601 Elmwood Ave, Box 704, Rochester, NY 14623; e-mail: charles_francis{at}urmc.rochester.edu.

This is a literature review of the frequency of venous thromboembolism in hospitalized patients with cancer and of the available evidence supporting the use of thromboprophylaxis. Patients with cancer are at particularly high risk of venous thromboembolism and account for almost 20% of patients in the population. Hospitalization is an important risk factor in patients with cancer, with rates reported between 0.6% and 7.8%. The incidence has been increasing over the past decade. Three randomized controlled trials and meta-analyses indicate that prophylaxis with low molecular weight heparin, heparin, or fondaparinux significantly reduces the rate of venous thromboembolism in hospitalized medical patients who are at high risk. Patients with cancer were included in these studies, but prospective trials specifically focused on patients with cancer are not available. Evidence indicates that appropriate thromboprophylaxis is provided to a minority of hospitalized patients with cancer and that targeted educational efforts and computerized prompt systems can increase appropriate use. Guidelines developed by both oncology and thrombosis organizations support the use of thromboprophylaxis in hospitalized patients with cancer. In conclusion, most patients hospitalized with cancer are at high risk of venous thromboembolism, and thromboprophylaxis should be provided in the absence of active bleeding or a high bleeding risk.

Supported in part by Grant No. RO1HL095109-01 from the National Heart, Lung, and Blood Institute, Bethesda, MD.

Author's disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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