Primary Thromboprophylaxis in Hospices: The Association Between Risk of Venous Thromboembolism and Development of Symptoms

Miriam J. Johnson, Brian McMillan, Caroline Marie Fairhurst, Rhian Gabe, Jason Ward, Jenny Wiseman, Bruce Pollington, Simon I.R. Noble

Research output: Contribution to journalArticlepeer-review


Context. Venous thromboembolism (VTE) risk assessment for adults admittedto hospital is commonplace, but the utility of assessment tools in patients admitted to hospices or palliative care units and prediction of symptomatic VTE is unknown.Objectives. To investigate the relationship between risk of VTE anddevelopment of symptoms.Methods. Retrospective consecutive admission, case-note data from seven U.K.hospices were collected during an evaluation of a VTE risk assessment protocolusing the Pan Birmingham Cancer Network palliative-modified ThromboembolicRisk Factors (THRIFT) Consensus Group criteria and presence/absence ofa temporary elevated risk (TER) of VTE. Symptoms/signs during admissionconsistent with possible VTE were documented.Results. A total of 1164 case-notes were analyzed (age range 23e99; men 627).THRIFT risk was high in 13%, medium in 83%, and low in 4%; a TER wasidentified in 24%. In the ‘‘clinically relevant group’’ (no contraindication, notanticoagulated), where primary thromboprophylaxis could have been prescribed(n ¼ 528), TER and symptoms were associated (21% symptoms with TER vs. 9%symptoms without TER: Chi-squared, P < 0.001). A high/moderate THRIFT scorehad a sensitivity of 98.4% (95% CI 91.3%e99.9%) and specificity of 5.8% (95% CI 3.9%e8.3%). The TER assessment had a more evenly balanced sensitivity (41.9%;95% CI 29.5%e55.2%) and specificity (79%; 95% CI 75.0%e82.6%).Conclusion. Hospice inpatients are at risk for VTE. TER alone is simpler to useand may be more useful in this population than the THRIFT but still haslimitations regarding ability to predict symptoms.
Original languageEnglish
Pages (from-to)56-64
Number of pages9
JournalJournal of pain and symptom management
Issue number1
Publication statusPublished - Jul 2014


  • venous thromboembolism
  • primary thromboprophylaxis
  • palliative

Cite this