Venous thromboembolism commonly occurs in patients with acute leukemia. We surveyed North American providers, and of the 151 responses, approximately half reported using pharmacologic anticoagulation during induction and consolidation treatment, while 15% did not use prophylaxis and 36% used mechanical methods and ambulation. These data highlight the need for further investigation and development of evidence-based guidelines for prophylaxis in this at-risk population.Background:
Venous thromboembolism (VTE) occurs in 2% to 12% of patients with acute leukemia (AL) despite disease- and therapy-associated thrombocytopenia, and it can be associated with significant morbidity and mortality. Because of the few high-quality studies, there are no evidence-based guidelines for VTE prophylaxis in this patient population. We sought to determine the spectrum of practice regarding prevention of VTE in patients with AL during induction and consolidation therapies.Methods:
We conducted a 19-question Web-based survey directed at North American providers caring for these patients. One hundred fifty-one of 215 responses received were eligible for analysis, with a response rate of 20.9% among physicians who treated leukemias.Results:
Overall, 47% and 45% of providers reported using pharmacologic VTE prophylaxis during induction and consolidation phases, respectively. Approximately 15% of providers did not provide any VTE prophylaxis, while 36% used mechanical methods and ambulation. Among providers who did not recommend pharmacologic prophylaxis, the most commonly cited reasons were the perceived high risk of bleeding (51%), absence of data supporting use (38%), and perceived low risk of VTE (11%).Conclusion:
Large, prospective studies are needed to define the safest and most effective approach to VTE prevention in patients with AL.