Abdel-Razeq Hikmat, Mansour Asem, Saadeh Salwa S, Abu-Nasser Mahmoud, Makoseh Mohammad, Salam Murad, Abufara Alaa, Ismael Yousef, Ibrahim Alaa, Khirfan Ghaleb, Ibrahim Mohammad
1 Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
2 Department of Radiology, King Hussein Cancer Center, Amman, Jordan.
Clin Appl Thromb Hemost. 2018 Apr;24(3):429-433. doi: 10.1177/1076029617692880. Epub 2017 Feb 9.
Venous thromboembolism (VTE) is a commonly encountered problem in patients with cancer. In recent years, cancer treatment paradigm has shifted with most therapy offered in ambulatory outpatient settings. Excess of half VTEs in patients with cancer occur in outpatient settings without prior hospitalization, where current practice guidelines do not recommend routine prophylaxis. Risk assessment models (RAMs) for VTE in such patients were recently introduced. This study aims to assess the practical application of one of these models in clinical practice. Medical records and hospital electronic database were searched for patients with cancer having VTE. Known risk factors were collected, and risk assessment was done using the Khorana RAM. Over a 10-year period, 346 patients developed VTE in ambulatory settings. Median age was 57 and 59.0% were females. Lower extremities were involved in 196 (56.6%), while 96 (27.7%) had pulmonary embolism. Most (76.6%) patients had stage IV disease, only 9.0% had stage I or II disease. Only 156 (45.1%) patients were on active chemotherapy, for whom Khorana risk assessment score was calculated. In these patients, high risk was identified in 31 (19.9%) patients, while 81 (51.9%) had intermediate risk and 44 (28.2%) had low risk. No patients were on prophylaxis prior to VTE. Most ambulatory patients with cancer who developed VTE were not on chemotherapy, and many of those who were on active treatment had low Khorana risk scores. This illustrates the need to modify the model or develop a new one that takes into consideration this group of patients.
静脉血栓栓塞症（VTE）是癌症患者中常见的问题。近年来，癌症治疗模式发生了转变，大多数治疗在门诊环境中进行。超过一半的癌症患者VTE发生在门诊，且无先前住院史，而目前的实践指南不建议进行常规预防。最近引入了此类患者VTE的风险评估模型（RAMs）。本研究旨在评估其中一种模型在临床实践中的实际应用。检索医疗记录和医院电子数据库以查找患有VTE的癌症患者。收集已知风险因素，并使用科拉纳RAM进行风险评估。在10年期间，346例患者在门诊环境中发生了VTE。中位年龄为57岁，女性占59.0%。196例（56.6%）累及下肢，96例（27.7%）发生肺栓塞。大多数（76.6%）患者为IV期疾病，仅9.0%为I期或II期疾病。只有156例（45.1%）患者正在接受积极化疗，并计算了科拉纳风险评估评分。在这些患者中，31例（19.9%）被确定为高风险，81例（51.9%）为中度风险，44例（28.2%）为低风险。VTE发生前没有患者接受预防。大多数发生VTE的门诊癌症患者未接受化疗，许多正在接受积极治疗的患者科拉纳风险评分较低。这表明需要修改该模型或开发一种考虑到这组患者的新模型。
