Tariq Marwa Akram, Mikhael Ehab Mudher
Department of Clinical Pharmacy, College of Pharmacy, University of Al-Qadisiyah, Al-Diwaniyah, Iraq.
Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq.
PLoS One. 2025 Jan 6;20(1):e0316801. doi: 10.1371/journal.pone.0316801. eCollection 2025.
Cancer-associated thrombosis (CAT) can increase morbidity and mortality for cancer patients. Therefore, guidelines recommend predicting VTE risk and thromboprophylaxis for high-risk patients. Many studies critique oncologists' adherence to thromboprophylaxis guidelines for cancer patients. Meanwhile, most of these studies did not discuss in detail the reasons and facilitators for oncologists' adherence to thromboprophylaxis guidelines. Therefore, the current study aimed to explore in depth the perceptions and practices of oncologists working in oncology centers in Baghdad, Iraq, regarding VTE and its risk assessment among ambulatory cancer patients. A qualitative study with face-to-face individual-based interviews was conducted with oncologists working in four major oncology centers in Baghdad, Iraq using a semi-structured interview guide. The guide was developed based on previous relevant literature and validated by a panel of experts. The interviews were conducted from November 2023 to January 2024. Thematic analysis approach was used for data analysis. Thirty-one oncologists were interviewed in this study. Twenty-two of the interviewed oncologists reported that they detect VTE among their cancer patients. 64% of participating oncologists reported that they did not conduct VTE risk assessments for their cancer patients. Only four oncologists reported assessing VTE risk using the Khorana score. 58% of oncologists reported that they prescribe thromboprophylaxis for high-risk patients; meanwhile, only 11% of them reported prescribing anticoagulants in a dose similar to that reported by thromboprophylaxis guidelines. 77% of participating oncologists reported that pharmacists have a significant role in preventing cancer-related thrombosis by helping physicians prescribe a safe and effective prophylactic anticoagulant and in calculating VTE risk scores. In conclusion, CAT is commonly diagnosed among Iraqi cancer patients. VTE risk assessment for ambulatory cancer patients is rarely conducted by oncologists working at Oncology centers in Baghdad, Iraq. The prophylactic anticoagulants were rarely prescribed in appropriate dose and/or duration for patients at high risk of VTE. Pharmacists can help oncologists follow thromboprophylaxis guidelines by calculating VTE risk score and recommending a safe and effective dose of appropriate prophylactic anticoagulant.Educating and training oncologists about VTE risk assessment is recommended to enhance their practice in thromboprophlaxis.
癌症相关血栓形成（CAT）会增加癌症患者的发病率和死亡率。因此，指南建议对高危患者进行静脉血栓栓塞（VTE）风险预测和血栓预防。许多研究批评肿瘤学家对癌症患者血栓预防指南的遵循情况。与此同时，这些研究大多没有详细讨论肿瘤学家遵循血栓预防指南的原因和促进因素。因此，本研究旨在深入探讨伊拉克巴格达肿瘤中心的肿瘤学家对门诊癌症患者VTE及其风险评估的看法和做法。采用基于个体面对面访谈的定性研究方法，对伊拉克巴格达四个主要肿瘤中心的肿瘤学家进行访谈，使用半结构化访谈指南。该指南是根据以往相关文献制定的，并经专家小组验证。访谈于2023年11月至2024年1月进行。采用主题分析法进行数据分析。本研究共访谈了31名肿瘤学家。22名受访肿瘤学家报告称，他们在癌症患者中检测到VTE。64%的参与研究的肿瘤学家报告称，他们没有对癌症患者进行VTE风险评估。只有4名肿瘤学家报告使用Khorana评分评估VTE风险。58%的肿瘤学家报告称，他们为高危患者开了血栓预防药物；与此同时，只有11%的肿瘤学家报告开出的抗凝剂剂量与血栓预防指南报告的剂量相似。77%的参与研究的肿瘤学家报告称，药剂师在预防癌症相关血栓形成方面发挥着重要作用，通过帮助医生开出安全有效的预防性抗凝剂以及计算VTE风险评分。总之，CAT在伊拉克癌症患者中很常见。伊拉克巴格达肿瘤中心的肿瘤学家很少对门诊癌症患者进行VTE风险评估。对于VTE高危患者，预防性抗凝剂很少按适当的剂量和/或疗程开具。药剂师可以通过计算VTE风险评分并推荐安全有效的适当预防性抗凝剂剂量，帮助肿瘤学家遵循血栓预防指南。建议对肿瘤学家进行VTE风险评估的教育和培训，以加强他们在血栓预防方面的实践。
