Risk factors for venous thromboembolic events at 90 days in hospitalized patients with advanced cancer receiving palliative care: a multicenter retrospective cohort study

Evidence regarding venous thromboembolism (VTE) risk in palliative care populations remains scarce, and current thromboprophylaxis recommendations are largely extrapolated from non-palliative oncology cohorts. This study aimed to determine the 90-day incidence of VTE and associated clinical risk factors in hospitalized patients with advanced cancer receiving palliative care. This multicenter retrospective cohort study included adults with advanced cancer enrolled in a palliative care program who were hospitalized between 2018 and 2024 at two tertiary care centers in Bogotá, Colombia. VTE incidence was calculated, and clinical risk factors were identified using multivariable Cox proportional hazards models. A total of 782 patients were included (mean age 61 years; 58.7% male). Withing 90 days of admission, 81 patients (10.3%) developed VTE, corresponding to an incidence density of 2.3 events per 1,000 patient-days. Pulmonary embolism accounted for 40.7% of VTE events. In the adjusted analysis, lung cancer was associated with an increased risk of VTE (HR 2.34; p = 0.010), whereas higher Karnofsky Performance Status was associated with a lower risk (HR 0.98; p = 0.020). Age, sex, body mass index, baseline hemoglobin, active anticancer treatment, and white blood cell count were not independently associated with VTE. Overall, 90-day mortality was 66.3%. VTE was a frequent complication among hospitalized patients with advanced cancer receiving palliative care. Lung cancer and poor functional status were independently associated with VTE, whereas traditional clinical predictors were not associated with VTE. These findings support individualized VTE risk assessment and highlight the need for future prospective studies evaluating thromboprophylaxis strategies in palliative care settings.