VENOUS THROMBOEMBOLIC EVENTS IN CANCER PATIENTS: ANALYSIS AND SOLUTIONS
The incidence of venous thromboembolic events (VTE) among cancer patients can be as high as 20%; the frequency of VTE revealed on postmortem examination of cancer patients can be as high as 50%; and the risk of death of cancer patients who developed VTE is four times as high as this parameter in similar patients without VTE. VTE in cancer patients is an important problem that affects the incidence, mortality rate, quality of life and prognosis. In our institution, following the analysis of complications for a period of 6 years (since 2012), a Decree regarding VTE prophylaxis has been introduced. High frequency of complications. Low frequency of the use of prophylaxis. Inadequate prophylactic measures. Insufficient duration of prophylaxis. Incorrect treatment. Goal prophylactic administration of LMWH is indicated for all outpatients with malignancies who receive chemotherapy and those patients who will undergo surgery. Evaluation of the risk of VTE in all patients admitted to hospital for inpatient treatment. Introduction of thromboprophylaxis into clinical practice. Introduction of VTE treatment algorithms. Materials: analysis of medical records of patients with venous thromboembolic complications, treatment options, strict following state-of-the-art recommendations that have been developed based on cumulative world experience of physicians of all specialties. Clinical cases demonstrating various treatment options for patients with VTE treated in Intensive Care Units. Methods: ‘therapeutic window’ for effective thrombolytic therapy for pulmonary thromboembolism (PTE) is not more than 14 days since the onset of symptoms. Patients with suspected PTE should be considered potential candidates for thrombolytic therapy if new symptoms of the disorder had developed within 2 weeks before they were admitted to the hospital. Indications for the use of therapeutic doses of LMWH in patients who developed VTE. Results: adequate prophylaxis was used in 38% of patients in hospitals before 2013, when no special attention was paid to this issue; in 62% of patients in hospitals, when physicians began to train to do it (lectures, clinical discussions) in 2013-2014; in 97% of patients in hospitals, when this education was updated by the development and mandatory use of a local protocol for determination of risk groups and adoption of SOPs for dealing with complications. 40% reduction in the frequency of VTE and 40% increase in the number of successfully treated patients of the total number of patients in our oncology clinic since 2017 compared to 2012 was due to the implementation of requirements defined by the Decree for VTE prophylaxis and treatment, their timely diagnosis and treatment.