Presentation (CTI)

OBJECTIVES: Metastatic ovarian cancer (OC) is associated with elevated venous thromboembolism (VTE) risk, yet predictors of VTE in this population remain understudied and evidence supporting oral anticoagulation in first-line chemotherapy settings is limited. This study evaluated whether a structured anticoagulation program could reduce VTE incidence in risk-selected OC patients receiving first-line chemotherapy.
METHODS: Patients receiving first-line chemotherapy for OC at a tertiary cancer center between 2020 and 2025 were included. A quality improvement program launched in July 2023 comprised staff education, EMR-integrated Khorana risk scoring, standardized apixaban prescribing protocols, and targeted chemotherapy suite questionnaires. VTE events were identified from imaging reports using natural language processing-enabled EMR data extraction. Descriptive statistics were used to compare patient cohorts before and after program implementation. Predictors of VTE were assessed using multivariable logistic regression.
RESULTS: Patient characteristics were comparable across the pre- and post-implementation cohorts. VTE rates decreased from 16.9% before program implementation to 12.5% following rollout. No increase in bleeding events or blood product utilization was observed. On multivariable analysis adjusting for established VTE risk factors, program implementation was a significant independent protective factor against VTE (adjusted OR 0.39, 95% CI 0.17 to 0.81; p=0.015).
CONCLUSIONS: A structured oral anticoagulation program incorporating risk stratification, clinical decision support, and standardized prescribing significantly reduced VTE events during first-line chemotherapy for ovarian cancer without increasing bleeding risk. These findings support the broader implementation of systematic thromboprophylaxis programs in high-risk oncology populations and highlight the value of real-world outcomes data in guiding quality improvement.