Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients

Carrier, Marc; Gal, Grégoire Le; Cho, R.; Tierney, Sarah; Rodger, Marc; Lee, A. Y.

doi:10.1111/j.1538-7836.2009.03326.x

Cited by 206 publications

(122 citation statements)

References 27 publications

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“…Only a very small number of patients successfully managed using further dose escalation of lmwh for additional recurrent events have been reported in the literature 20 . Although the use of plasma antifactor Xa has been suggested to guide further dose escalation 28 , our recommendation is based solely on expert opinion.…”

Section: Recurrent Cancer-associated Thrombosismentioning

confidence: 99%

“…In patients treated for cancerassociated thrombosis, the 6-month incidence of recurrent vte is 14% for those receiving warfarin and 7% for those receiving lmwh monotherapy 25 . Three retrospective cohort studies reported on the efficacy and safety of a full therapeutic dose of lmwh for the management of recurrent vte despite anticoagulation with warfarin 20,26,27 . Similarly, two retrospective cohort studies assessed the use of lmwh dose escalation for patients with recurrent vte despite treatment with lmwh 20,26 .…”

Section: Recurrent Cancer-associated Thrombosismentioning

confidence: 99%

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Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

et al. 2015

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general population is increased by a factor of 4 1 . In the cancer patient population, thromboembolism is associated with significant morbidity and mortality, and it is the second most common cause of death after cancer progression 2 . A number of published clinical practice guidelines have provided recommendations to medical oncologists for the management of cancer-associated thrombosis 3-5 ; however, currently available guidelines do not provide recommendations for challenging clinical situations (for example, thrombocytopenia, recurrent vte, catheter-related upper extremity dvt, etc.) encountered by health care practitioners caring for this patient population. METHODSThe purpose of the consensus process was to develop specific recommendations and to provide expert guidance for challenging cases that are not currently addressed in clinical practice guidelines on the treatment and prevention of vte in patients with cancer. The specific questions to be addressed were identified by the participants and supplemented by a systematic review of the available literature. Sources and SearchesFor each of the identified challenges, the literature in medline (1946 to March 2014), embase (1947 to March 2014), the Cochrane Central Register of Controlled Trials, and all Evidence Based Medicine Reviews (using the ovid interface) was systematically reviewed. References in included studies and previous systematic reviews were also reviewed for additional potential studies. The search was limited to human studies reported in the English language. One of the medline search strategies is depicted in Table i. Grading of the Evidence and Consensus ProcessThe multidisciplinary expert consensus group, which included 21 voting participants with expertise ABSTRACTVenous thromboembolism is a common complication in cancer patients, and thromboembolism is the second most common cause of death after cancer progression. A number of clinical practice guidelines provide recommendations for the management of cancerassociated thrombosis. However, the guidelines lack recommendations covering commonly encountered clinical challenges (for example, thrombocytopenia, recurrent venous thromboembolism, etc.) for which little or no evidence exists. Accordingly, recommendations were developed to provide expert guidance to medical oncologists and other health care professionals caring for patients with cancer-associated thrombosis. The current expert consensus was developed by a team of 21 clinical experts. For each identified clinical challenge, the literature in medline, embase, and Evidence Based Medicine Reviews was systematically reviewed. The quality of the evidence was assessed, summarized, and graded. Consensus statements were generated, and the experts voted anonymously using a modified Delphi process on their level of agreement with the various statements. Statements were progressively revised through separate voting iterations and were then finalized. Clinicians using these recommendations and suggestions should tailor patient management accord...

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Section: Recurrent Cancer-associated Thrombosismentioning

confidence: 99%

Section: Recurrent Cancer-associated Thrombosismentioning

confidence: 99%

Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

et al. 2015

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“…The 2013 international CPGs relied on one retrospective cohort study 81 Symptomatic catheter-associated thrombosis occurs in 3·0-5·0% of patients with cancer requiring venous access, which increases to as much as 30·0% when including asymptomatic cases. 21 Since 2013, one new retrospective study 83 One meta-analysis 85 assessed the benefi t-to-risk ratio of diff erent anticoagulants in 2564 patients with catheterassociated thrombosis.…”

Section: Vte Recurrence In Patients With Cancer On Anticoagulation Mementioning

confidence: 99%

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Farge

Bounameaux

Brenner

et al. 2016

The Lancet Oncology

390

434

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Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at an increased risk of developing VTE and are more likely to have a recurrence of VTE and bleeding while taking anticoagulants. Management of VTE in patients with cancer is a major therapeutic challenge and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME), established to reduce the global burden of VTE in patients with cancer, published international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis. The rapid global adoption of direct oral anticoagulants for management of VTE in patients with cancer is an emerging treatment trend that needs to be addressed based on the current level of evidence. In this Review, we provide an update of the ITAC-CME consensus recommendations based on a systematic review of the literature ranked according to the Grading of Recommendations Assessment, Development, and Evaluation scale. These guidelines aim to address in-hospital and outpatient cancer-associated VTE in specifi c subgroups of patients with cancer.

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“…However, there is no high‐quality evidence to guide practice in this situation. Recommendations from major guidelines including changing oral anticoagulants to LMWH or escalating LMWH doses by 20%‐25% are based on limited retrospective studies 52, 53, 54. The results of a registry study addressing this issue were reported recently, including 212 cancer patients with recurrent VTE on anticoagulation 55.…”

Section: Treatment Of Cancer‐associated Thrombosismentioning

confidence: 99%

Managing thrombosis in cancer patients

Wang

García

2018

Research and Practice in Thrombosis and Haemostasis

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Venous thromboembolism is a major complication in cancer patients. The basis for the strong association between cancer and thrombosis remains incompletely understood, and the optimal approaches to both the treatment and the prevention of cancer‐associated thrombosis are evolving. Here we review several important topics related to cancer‐associated thromboembolism, including the pathogenesis, prevention, and management of this disease. Wherever possible, we include evidence from clinical trials, including the results of recently published trials that compared direct oral anticoagulants to low‐molecular‐weight heparin for the treatment of cancer‐associated thrombosis.

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Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients

Cited by 206 publications

References 27 publications

Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Managing thrombosis in cancer patients

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