PB1425 - Thromboprophylaxis in ambulatory patients with cancer on chemotherapy: the value of internal medicine assessment beyond risk assessment scores

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

LC

Leonardo Augusto Ciuffini

MD
Department of Hematology, Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Milan, Lombardia, Italy

Co-Author(s)

Maria Elisa Mancuso, MD, PhD

Senior Consultant in Haematology
Centre for Thrombosis and Haemorrhagic Diseases, IRCCS Humanitas Research Hospital
Milan, Lombardia, Italy
LL

Luca Librè

MD
Department of Hematology, Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Milan, Lombardia, Italy
CS

Clara Sacco

MD
Department of Hematology, Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Milan, Lombardia, Italy
PF

Paola Ferrazzi

MD
Department of Hematology, Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Milan, Lombardia, Italy
MD

Marco Paolo Donadini

Professor
University of Varese
Varese, Lombardia, Italy
AS

Alessandro Squizzato

Professor
University of Varese
Varese, Lombardia, Italy
Walter Ageno, MD

Professor
University of Varese
Bellinzona, Ticino, Switzerland
CL

Corrado Lodigiani

MD, PhD
Department of Hematology, Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Milan, Lombardia, Italy

Background: Cancer-associated thrombosis is a significant cause of morbidity and mortality among patients with cancer. Thromboprophylaxis prevents short- and long-term sequelae with relevant impact on quality of life and life expectancy. Risk assessment models (RAMs) are considered the cornerstone to establish proper indication for thromboprophylaxis in cancer patients, but their sensitivity and specificity in the outpatient setting is still lacking. Moreover, RAMs do not include some variables which are considered relevant to assess the thrombotic risk and the consequent indication for thromboprophylaxis.

Aims: To evaluate whether a personalized protocol visit model based on relevant risk factors for thrombosis combined with RAMs increase VTE prevention with similar safety outcomes as compared with only RAM-based model

Methods: From June 2013 to June 2023 we conducted an open-label study including all consecutive outpatients with active cancer naïve to chemotherapy who underwent clinical evaluation to establish whether or not thromboprophylaxis was deemed necessary or not. Patients underwent venous Doppler ultrasound to exclude those who had deep vein thrombosis needing anticoagulation. The clinical assessment included medical history, performance status, laboratory exams, RAMs (Khorana and PROTECHT scores), type of cancer, and type of prescribed chemotherapy. Primary endpoints were incidence rates of VTE and major bleedings (MB)

Results: Overall, 610 pts were included, of whom 402 had complete data. Of those 224 (55.7%) were considered eligible for thromboprophylaxis. The most common cancer types were colorectal (189, 47%), brain (129, 32%), pancreatic (80, 20%), lung (66, 16%) and stomach (40, 10%). Majority had advanced stage disease (275, 68.4%). Efficacy and safety outcomes comparing pts who received thromboprophylaxis and those who did not are shown in Table 1.

Conclusion(s): Our protocol visit model allowed a personalized risk evaluation, showing a not increased adverse events rate in pts on prophylaxis and a meaningful efficacy on VTE prevention.