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This version was published on May 1, 2008
American Journal of Hospice and Palliative Medicine®, Vol. 25, No. 2, 127-131 (2008)
DOI: 10.1177/1049909107310142
© 2008 SAGE Publications

Use of Thromboprophylaxis in Palliative Care Patients: A Survey Among Experts in Palliative Care, Oncology, Intensive Care, and Anticoagulation

Katharina A. Kierner, MD

Unit of Palliative Care, Department of Medicine I, Medical University of Vienna, Austria

Verena Gartner, MD

Unit of Palliative Care, Department of Medicine I, Medical University of Vienna, Austria

Maria Schwarz, MD

Unit of Palliative Care, Department of Medicine I, Medical University of Vienna, Austria

Herbert H. Watzke, MD

Unit of Palliative Care, Department of Medicine I, Medical University of Vienna, Austrian, herbert.watzke{at}meduniwien.ac.at

Study-based guidelines on thromboprophylaxis are not available for palliative care patients. The authors asked a panel of academic medical experts in palliative care, oncology, blood coagulation, and intensive care to select a prophylactic regimen out of 5 predefined options for a virtual patient with advanced bronchial cancer in different clinical settings. Primary prophylaxis for venous thromboembolism was withdrawn by all physicians when the patient had a Karnovsky's index of 10 and was described as dying. It was given by 25% of physicians when the patient had a Karnovsky's index of 20 and by 85% when Karnovsky's index 40 was still 40. Similar results were obtained in the situation of secondary prophylaxis of venous thromboembolism and when the patient was described as having a history of chronic atrial fibrillation. This data clearly show that thromboprophylaxis is delivered according to a compound estimate of risks and benefits of such prophylaxis in a specific palliative care situation.

Key Words: palliative care • thrombosis • prophylaxis • low—molecular weight heparin • clinical stage


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