Kanser Hastalarında Tromboz Riskinin ve Antikoagülan Tedavinin Rehbere Uygunluğunun Değerlendirilmesi
Kandemir, Esin Aysel
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Cancer patients are at high risk for venous thromboembolism (VTE) and cancer-associated VTE is a major health problem due to its effects on deterioration of disease prognosis, increased treatment costs and delayed cancer treatment. This study aimed to assess the adherence of anticoagulant therapies of cancer inpatients to the National Comprehensive Cancer Network cancer-associated VTE guidelines, to identify the VTE risk profiles of cancer outpatients using the Khorana risk assessment tool and to inform the physicians about patients at high risk. Furthermore, the attitudes and opinions of medical oncologists on anticoagulant therapy in cancer patients was assessed via a survey. As a result, the guideline adherence was assessed retrospectively and prospectively, and an increase in adherence was observed after the guideline-related recommendations made by a clinical pharmacist regarding the initiation of prophylactic anticoagulant upon hospital admission and the appropriate dosing of anticoagulant drug (p=0.002; p=0.001; McNemar Test) in the prospective group. A total of 68 recommendations for 60 cancer inpatients were made by a clinical pharmacist and 32.35% was accepted. Among the outpatients, at high risk patients for VTE (5.5%) were identified, then the consultant physicians were informed. According to the results of the survey, it was shown that the most of medical oncologists particularly consider the risk factors (for inpatients and outpatients) as; a history of VTE (55% and 58%), immobilization (52% and 50%) and tumor/cancer type (42% and 40%) while initiating anticoagulants in cancer patients. It was found that 40.3% of the physicians usually prefer to use anticoagulants for the inpatients and 77.4% of the physicians sometimes prefer to use for the outpatients. The physicians (%) indicated that a clinical pharmacist should be presented in the multidisciplinary team for the issues related with drug interactions (73.8%), patient education (65.6%), dose adjustment (36.1%) and the risk assessment (24.6%). In conclusion, a clinical pharmacist can contribute into the maintenance of cancer related VTE therapy according to the guideline and in the VTE risk assessment of cancer patients by playing an active role in treatment process.