Research Article Open Access

Clinical outcomes of implementing evidence-based practice on venous thromboembolism prevention for cancer patients in Qatar, a retrospective study

Abstract

Purpose: Venous Thrombo Embolism (VTE) disease is a serious condition; approximately 20% of all VTE cases occur in patients with cancer and it is a significant cause of morbidity and mortality in cancer patients. Plus, it is a significant predictor of increased mortality during the first year after diagnosis among all types and stages of cancer. Furthermore, VTE affects up to 20% of patients with cancer before death and has been reported in up to half of patients at the time of postmortem examination. Most hospitalized patients with cancer require thromboprophylaxis throughout hospitalization [3]. This study was performed in the National Centre for Cancer Care and Research (NCCCR); the only tertiary care cancer center in Qatar. NCCCR is 1out of 8 teaching hospitals in Hamad Medical Corporation (HMC) the main and largest healthcare organization in Qatar. An evidence based protocol for of VTE risk assessment and VTE prophylaxis was initiated in June 2011, piloted till December 2011, and then fully implemented in January 2012 to all cancer patients admitted to inpatients wards. This study focuses on the assessment of the clinical outcome in preventing VTE amongst cancer population in Qatar after implementation of evidence based thromboprophylaxis guidelines. Primary outcome: to measure the incidence rate of DVT before and after implementation of   thromboprophylaxis protocol. Secondary outcome: measuring physician compliance rate with the guidelines. Methods: A retrospective study was conducted to evaluate the incidence of DVT by evaluating doppler ultrasound (US) database for 364 cases of inpatients and outpatients over 24month (from January 2011 through December 2012) study period, all findings were retrospectively analyzed by a hematologist to identify patients who developed deep vein thrombosis (DVT) due to any current or previous admission (within 30 days before the doppler US). The relationship between the incedence of devloping VTE over time and the complinece to VTE prevention protocol were established by correlation and regression analysis. Statistical analyses are done using excel and statistical packages SPSS 20.0. Findings: The study showed that the overall compliance to VTE prophylaxis protocol introduced to inpatients population (n = 2595) increased from 61.5% to 84.6% with (p = 0.0297), the incidence of DVT decreased by 66.4% (P= 0.0145), which was correlated with a significant increase in the percentage of patients who received adequate VTE thromboprophylaxis. A percentage of 78% of patients developed DVT during admission in 2011 did not receive prophylaxis, compared to 29% in 2012. While this could be seen as a positive impact of thrombophylaxis, the number of patients who developed DVT despite receiving appropriate prophylaxis, increased from 22% in 2011 to 71% in 2012. Implications: Appropriate Thrombophylaxis could considerably improve the incidence of DVT in cancer patients. The majority of VTE in cancer patients occurred due to inappropriate prophylaxis, however the minority was due to prophylaxis failure, which raised the importance of implementing evidence based practice for thromboprophylaxis among hospitalized cancer patients.

Shereen Elazzazy

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