BACKGROUND The prevalence of deep venous thrombosis in patients with advanced cancer is unconfirmed and it is unknown whether current international thromboprophylaxis guidance is applicable to this population. We aimed to determine prevalence and predictors of femoral deep vein thrombosis in patients admitted to specialist palliative care units (SPCUs). METHODS We did this prospective longitudinal observational study in five SPCUs in England, Wales, and Northern Ireland (four hospices and one palliative care unit). Consecutive adults with cancer underwent bilateral femoral vein ultrasonography on admission and weekly until death or discharge for a maximum of 3 weeks. Data were collected on performance status, attributable symptoms, and variables known to be associated with venous thromboembolism. Patients with a short estimated prognosis (<5 days) were ineligible. The primary endpoint of the study was the prevalence of femoral deep vein thrombosis within 48 h of SPCU admission, analysed by intention to treat. This study is registered with the ISRCTN registry, number ISRCTN97567719. FINDINGS Between June 20, 2016, and Oct 16, 2017, 343 participants were enrolled (mean age 68·2 years [SD 12·8; range 25-102]; 179 [52%] male; mean Australian-modified Karnofsky performance status 49 [SD 16·6; range 20-90]). Of 273 patients with evaluable scans, 92 (34%, 95% CI 28-40) had femoral deep vein thrombosis. Four participants with a scan showing no deep vein thrombosis on admission developed a deep vein thrombosis on repeat scanning over 21 days. Previous venous thromboembolism (p=0·014), being bedbound in the past 12 weeks for any reason (p=0·003), and lower limb oedema (p=0·009) independently predicted deep vein thrombosis. Serum albumin concentration (p=0·43), thromboprophylaxis (p=0·17), and survival (p=0·45) were unrelated to deep vein thrombosis. INTERPRETATION About a third of patients with advanced cancer admitted to SPCUs had a femoral deep vein thrombosis. Deep vein thrombosis was not associated with thromboprophylaxis, survival, or symptoms other than leg oedema. These findings are consistent with venous thromboembolism being a manifestation of advanced disease rather than a cause of premature death. Thromboprophylaxis for SPCU inpatients with poor performance status seems to be of little benefit. FUNDING National Institute for Health Research (Research for Patient Benefit programme).

中文翻译：

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专科姑息治疗病房 (HIDDen) 晚期癌症患者深静脉血栓形成的患病率、症状负担和自然史：一项前瞻性纵向观察研究。

背景 晚期癌症患者深静脉血栓形成的患病率尚未得到证实，目前的国际血栓预防指南是否适用于该人群尚不清楚。我们旨在确定入住专科姑息治疗病房 (SPCU) 的患者股骨深静脉血栓形成的患病率和预测因素。方法 我们在英格兰、威尔士和北爱尔兰的五个 SPCU（四个收容所和一个姑息治疗单元）中进行了这项前瞻性纵向观察研究。连续成年癌症患者在入院时和每周接受双侧股静脉超声检查，直至死亡或出院，持续时间最长为 3 周。收集有关体能状态、归因症状和已知与静脉血栓栓塞相关的变量的数据。估计预后较短的患者（< 5 天）不合格。该研究的主要终点是 SPCU 入院后 48 小时内股骨深静脉血栓形成的患病率，按治疗意向进行分析。本研究已在 ISRCTN 登记处注册，编号为 ISRCTN97567719。调查结果 2016 年 6 月 20 日至 2017 年 10 月 16 日期间，招募了 343 名参与者（平均年龄 68·2 岁 [SD 12·8；范围 25-102]；179 名 [52%] 男性；平均澳大利亚改良的 Karnofsky 表现状态49 [标准差 16·6；范围 20-90]）。在 273 名扫描结果可评估的患者中，92 名（34%，95% CI 28-40）患有股骨深静脉血栓形成。4 名入院时扫描显示没有深静脉血栓形成的参与者在 21 天的重复扫描中发展为深静脉血栓形成。既往有静脉血栓栓塞史 (p=0·014)，过去 12 周内因任何原因卧床不起 (p=0·003)，和下肢水肿 (p=0·009) 独立预测深静脉血栓形成。血清白蛋白浓度 (p=0·43)、血栓预防 (p=0·17) 和生存 (p=0·45) 与深静脉血栓形成无关。解读 大约三分之一入住 SPCU 的晚期癌症患者有股骨深静脉血栓形成。深静脉血栓形成与血栓预防、生存或腿部水肿以外的症状无关。这些发现与静脉血栓栓塞症是晚期疾病的表现而不是过早死亡的原因相一致。体能状态不佳的 SPCU 住院患者的血栓预防似乎收效甚微。资助国家健康研究所（患者福利计划研究）。血栓预防 (p=0·17) 和生存 (p=0·45) 与深静脉血栓形成无关。解读 大约三分之一入住 SPCU 的晚期癌症患者有股骨深静脉血栓形成。深静脉血栓形成与血栓预防、生存或腿部水肿以外的症状无关。这些发现与静脉血栓栓塞症是晚期疾病的表现而不是过早死亡的原因相一致。体能状态不佳的 SPCU 住院患者的血栓预防似乎收效甚微。资助国家健康研究所（患者福利计划研究）。血栓预防 (p=0·17) 和生存 (p=0·45) 与深静脉血栓形成无关。解读 大约三分之一入住 SPCU 的晚期癌症患者有股骨深静脉血栓形成。深静脉血栓形成与血栓预防、生存或腿部水肿以外的症状无关。这些发现与静脉血栓栓塞症是晚期疾病的表现而不是过早死亡的原因相一致。体能状态不佳的 SPCU 住院患者的血栓预防似乎收效甚微。资助国家健康研究所（患者福利计划研究）。深静脉血栓形成与血栓预防、生存或腿部水肿以外的症状无关。这些发现与静脉血栓栓塞症是晚期疾病的表现而不是过早死亡的原因相一致。体能状态不佳的 SPCU 住院患者的血栓预防似乎收效甚微。资助国家健康研究所（患者福利计划研究）。深静脉血栓形成与血栓预防、生存或腿部水肿以外的症状无关。这些发现与静脉血栓栓塞症是晚期疾病的表现而不是过早死亡的原因相一致。体能状态不佳的 SPCU 住院患者的血栓预防似乎收效甚微。资助国家健康研究所（患者福利计划研究）。