The current knowledge and execution status of venous thromboembolism prevention and management among critical care practitioners of cancer hospitals in China: a muticenter survery / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the current knowledge and execution status of venous thromboembolism (VTE) prevention and management among critical care practitioners in cancer hospitals in China. Methods A self-designed electronic questionnaire was used to survey the registered medical members from the Critical Care Medicine Society of China Anti-Cancer Association (CACA), 409 practitioners participated in the survey with validated questionnaires. The respondents were divided into physician group (n = 142) and nurse group (n = 267) according to the occupation. The practitioners' basic knowledge situation of VTE prevention, the daily practice of VTE prophylaxis, and the prevention of anti-coagulation situation in patients undergoing tumor surgery and non-surgery treatment were analyzed. Results Respondents from 24 Departments of Critical Care Medicine of Cancer Hospitals in 17 provinces and 4 municipalities across China participated in the survey, accounting for 29.0% of the total registered members of the Critical Care Medicine Society of CACA. ① Practitioners' current basic knowledge and attitude of VTE prevention45.8% (11/24) of the hospitals involved in the survey had established VTE quality control system; 66.5% (272/409) of the respondents very concerned about VTE; the proportion of respondents very concerned about VTE [83.8% (119/142) vs. 57.3% (153/267)] and proportion of respondents who thought that VTE had a significant effect on prognosis [84.5% (120/142) vs. 74.9% (200/267)] in physician group were significantly higher than those in nurse group (both P < 0.05); a similar proportion of the respondents in physician and nurse groups suggested energetic prevention of VTE should be carried out [70.4% (100/142) vs. 69.3% (185/267), P > 0.05]. ② Daily practice of VTE prevention compared with American College of Chest Physicians (ACCP) and National Comprehensive Cancer Network (NCCN) guidelines, the proportion of the respondents who were familiar with the VTE guidelines from the Chinese society of clinical oncology (CSCO) was significantly higher [61.4% (251/409) vs. 38.9% (159/409), 38.1% (156/409)]; 99.0% (405/409) of the respondents believed guidelines were necessary for the VTE prevention and management of critically ill cancer patients, meanwhile 60.6% (248/409) suggested the implementation of the current guidelines needed to be adjusted according to the clinical practical situation; 85.1% (348/409) of the respondents performed regular VTE risk assessment in clinical practice; 81.9% (335/409) implemented VTE prevention strategy based on difference in risk stratification results; 66.7% (273/409) of the respondents selected Caprini score recommended by the guidelines for VTE risk assessment. ③ VTE prophylaxis for critically ill cancer patients for postoperative cancer patients, 78.5% (321/409) of the respondents implemented both mechanical prophylaxis and anticoagulants for prevention of VTE, 66.3% (271/409) respondents discontinued the mechanical prophylaxis and 54.0% (221/409) discontinued prophylactic anticoagulation once the patients were ambulatory; for patients with critical cancer illness under medical treatment, only 9.5% (39/409) of the respondents routinely implemented prophylactic anticoagulation, while the majority of respondents 82.4% (337/409) implemented prophylactic anticoagulation based on a comprehensive risk assessment for bleeding; 61.1% (250/409) discontinued mechanical prophylaxis and 42.3% (173/409) discontinued prophylactic anticoagulation once the patients were ambulatory. Conclusions The results of this nation-wide survey reveal the current knowledge and practice status of the VTE prevention and management among critical care practitioners in China, indicating that VTE prophylactic anti-coagulation practice for critically ill cancer patients is still suboptimal. The present guidelines are not directing to the VTE preventive works for such patients, resulting in that the VTE preventive strategy remains largely based on experiences of medical workers rather than scientific evidence from clinical trials. Establishing and improving expert consensus or guidelines for critical cancer patients are beneficial and of great importance to elevate the level of standardizing prevention and management of VTE in China.