Assessing the risk of venous thromboembolism (VTE) in ambulatory patients with cancer: Rationale and implementation of a pharmacist-led VTE risk assessment program in an ambulatory cancer centre.

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Abstrakt

Tytuł:: Assessing the risk of venous thromboembolism (VTE) in ambulatory patients with cancer: Rationale and implementation of a pharmacist-led VTE risk assessment program in an ambulatory cancer centre.
Autorzy:: Pelletier R; School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada.
Źródło:: Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners [J Oncol Pharm Pract] 2021 Jun; Vol. 27 (4), pp. 911-918. Date of Electronic Publication: 2021 Mar 24.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: London : SAGE Publications
Original Publication: Norwalk, CT : Appleton & Lange, c1995-
MeSH Terms:: Outpatient Clinics, Hospital*
Pharmacists*
Ambulatory Care/*methods
Neoplasms/*complications
Venous Thromboembolism/*diagnosis
Anticoagulants/therapeutic use ; Guidelines as Topic ; Humans ; Mass Screening ; Neoplasms/epidemiology ; Ontario ; Patient Care Team ; Pharmacy Service, Hospital ; Predictive Value of Tests ; Risk Assessment ; Risk Factors ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/prevention & control
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Contributed Indexing:: Keywords: Risk prediction models; ambulatory care; anticoagulation; venous thromboembolism
Substance Nomenclature:: 0 (Anticoagulants)
Entry Date(s):: Date Created: 20210324 Date Completed: 20210618 Latest Revision: 20210629
Update Code:: 20240105
PubMed Central ID:: PMC8193586
DOI:: 10.1177/10781552211004705
PMID:: 33757321
: Czasopismo naukowe

Objectives: The objectives of this paper were to identify and compare clinical prediction models used to assess the risk of venous thromboembolism (VTE) in ambulatory patients with cancer, as well as review the rationale and implementation of a pharmacist-led VTE screening program using the Khorana Risk Score model in an ambulatory oncology centre in Sault Ste. Marie, Ontario, Canada.
Data Sources: PubMed was used to identify clinical practice guidelines and review articles discussing risk prediction models used to assess VTE risk in ambulatory patients with cancer.
Data Summary: Three commonly used VTE risk prediction models in ambulatory patients with cancer: the Khorana Risk Score, Vienna Cancer and Thrombosis Study (CATS) and Protecht Score, were identified via literature review. After considering guideline recommendations, site-specific factors (i.e. laboratory costs, time pharmacists spent calculating VTE risk) and evidence from the CASSINI and AVERT trials, a novel pharmacist-led VTE risk assessment program using the Khorana Risk Score was developed during a fourth-year PharmD clinical rotation at the Algoma District Cancer Program (ADCP) [ambulatory cancer care centre]. ADCP patients with a Khorana Risk Score of ≥ 2 were referred to the hematologist for a full VTE workup. Considering limitations, inclusion and exclusion criteria of the CASSINI and AVERT trials, the hematologist and pharmacy team decided on appropriate initiation of thromboprophylaxis with a direct oral anticoagulant (DOAC).
Conclusions: The Khorana Risk Score was the chosen model used for the pharmacist-led VTE risk assessment program due to its user-friendly scoring algorithm, evidence from validation studies and clinical trials, as well as ease of integration into pharmacy workflow. More research is needed to determine if pharmacist-led VTE risk assessment programs will impact patient outcomes, such as morbidity and mortality, secondary to cancer-associated thrombosis.

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