PGY2 Oncology Pharmacy Resident UC Davis Health Sacramento, California, United States
Poster Abstract:
Background: Active cancer and body mass index (BMI) greater than 30 kg/m2 can increase the risk of venous thromboembolism (VTE) in hospitalized patients by 96% and 12%, respectively. Pharmacologic thromboprophylaxis has been shown to reduce the rate of hospital-acquired venous thromboembolism (HA-VTE) from 3.44% to 0.06%; however, proper dosing strategies among patients with obesity, especially those with concomitant cancer, remain uncertain due to limited data. In a quality improvement study conducted at the University of California Davis Health, VTE prophylaxis dosing strategies in obese patients were evaluated. It was observed that HA-VTE occurred in 24% of patients receiving standard dose enoxaparin, defined as 40 mg subcutaneously once daily, with BMI greater than 30 kg/m2 and half of those patients had an active cancer diagnosis. We hypothesize that escalated dosing of enoxaparin for VTE prophylaxis may potentially be associated with a lower incidence of HA-VTE and no increase bleeding rates, in patients with obesity and cancer. Our study aims to evaluate the rates of HA-VTE in patients with active malignancy and obesity, in efforts to optimize thromboprophylaxis strategies in this unique population.
Methods: This multi-center, retrospective cohort study will compare standard enoxaparin dosing with escalated enoxaparin dosing for VTE prophylaxis in patients with obesity and cancer. The primary outcome will assess the rate of HA-VTE. Secondary outcomes include VTE type, and incidence of bleeding events as defined by the International Society on Thrombosis and Hemostasis criteria. Data will be collected from electronic medical record encounters at the following University of California Medical Centers: Davis, Irvine, Los Angeles, San Diego, and San Francisco. Eligible patients will include adults (18 years of age or older), those with a BMI greater than 30mg/m2, and those on an antineoplastic agent during study period, who received enoxaparin for VTE prophylaxis during their hospitalization between January 1, 2020, through August 17, 2023. A chi-squared statistical test will be utilized to analyze the primary outcome and multivariable analysis will be conducted to determine association of various risk factors such as BMI, cancer type, and treatment site with VTE incidence.
References (must also be included in final poster): Neeman E, Liu V, Mishra P, Thai KK, Xu J, Clancy HA, Schlessinger D, Liu R. Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients. JAMA Netw Open. 2022 Nov 1;5(11):e2240373. doi: 10.1001/jamanetworkopen.2022.40373. PMID: 36409498; PMCID: PMC9679881
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Abukhalil AD, Nasser A, Khader H, Albandak M, Madia R, Al-Shami N, Naseef HA. VTE Prophylaxis Therapy: Clinical Practice vs Clinical Guidelines. Vasc Health Risk Manag. 2022 Sep 2;18:701-710. doi: 10.2147/VHRM.S382050. PMID: 36082196; PMCID: PMC9447404.
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