Evaluation and Optimization of Thromboprophylaxis in Hospitalized Cancer Patients by Pharmacist Intervention
Iranian Journal of Pharmaceutical Sciences,
Vol. 22 No. 1 (2026),
26 January 2026
,
Page 433-441
https://doi.org/10.22037/ijps.v22i1.51560
Abstract
Venous thromboembolism (VTE) is the second leading cause of death in cancer patients. This clinical survey aimed to study thromboprophylaxis in hospitalized cancer patients and the pharmacist's role in optimizing anticoagulant administration. Three hundred and three cancer patients were categorized into three groups: mild (5.9%), moderate (57.1%), and severe (37%), based on the Padua Prediction Score and Khorana score for VTE risk. The pharmacist evaluated all cases in accordance with thromboprophylaxis guidelines and recommended changes to anticoagulant therapy (switching from enoxaparin to unfractionated heparin for cost reasons) or initiation of therapy. The primary reasons for physicians' reluctance to initiate or change anticoagulants were also examined. Among the 303 hospitalized cancer patients evaluated, 285 (94.1%) required thromboprophylaxis based on the Padua and Khorana scores. Of these, 159 (55.8%) were already receiving anticoagulants, while 126 (44.2%) were not. Following the pharmacist’s evaluation, heparin was recommended for 126 untreated patients, and physicians accepted the recommendation in 22 cases (17.5%), disagreed in 71 (56.3%), and 33 patients (26.2%) were unavailable for intervention. Among the 108 patients receiving enoxaparin, switching to heparin was proposed for economic optimization. Physicians agreed in 36 cases (33.3%), disagreed in 61 (56.5%), and 11 patients (10.2%) were unavailable for intervention. The main physician-related reasons for not initiating or changing therapy included preference for enoxaparin as first-line therapy, concerns about thrombocytopenia, or the patient's terminal condition. Overall, pharmacist interventions improved adherence to thromboprophylaxis guidelines and resulted in treatment initiation or switching in 58 of the 190 patients available for these interventions (30.5%), demonstrating significant clinical and economic benefits. Assessing VTE risk in cancer patients using the Padua Prediction Score and Khorana score provides a rational basis for prescribing anticoagulants. Collaboration with pharmacists in selecting and administering appropriate anticoagulants (type, dose, duration) can help reduce costs and improve outcomes in cancer patients.
- Cancer
- Thromboprophylaxis
- Heparin
- Pharmacist intervention
- DOAC
- Enoxaparin
How to Cite
References
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