Dose escalation of low molecular weight heparin in patients with recurrent cancer-associated thrombosis

Ihaddadene, Ryma; Gal, Grégoire Le; Delluc, Aurélien; Carrier, Marc

doi:10.1016/j.thromres.2014.04.028

Cited by 58 publications

(33 citation statements)

References 16 publications

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“…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%

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%

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

et al. 2015

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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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“…Beside non-compliance and mechanical vein compression by the tumour, heparin-induced thrombocytopenia should be ruled out in patients receiving LMWH. Subsequently, based on two retrospective cohort studies, increasing the LMWH dosage by 20-25 % is recommended in patients, in whom the VTE event has occurred during full-dose therapy [47,48]. Measuring plasma anti-Xa activ- .…”

Section: How Long Should the Patient Be Anticoagulated?mentioning

confidence: 99%

Management of cancer-associated venous thromboembolism – a case-based practical approach

Voigtlaender

2018

Vasa

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Summary:In patients with solid tumours or haematological malignancies, venous thromboembolism (VTE) is a leading cause of death and signifi cantly contributes to morbidity and healthcare resource utilization. Current practice guidelines recommend long-term anticoagulation with low-molecular-weight heparin (LMWH) as the treatment of choice for cancer-associated VTE, based on clinical trial data showing an overall improved safety and effi cacy profi le of LMWH compared to vitamin K antagonists.However, several open questions remain, e. g. with regard to the intensity and duration of LMWH therapy; moreover, recent realworld evidence indicates that adherence to parenteral anticoagulation with LMWH over the course of treatment is poor in clinical practice. In this regard, the direct oral factor Xa or thrombin inhibitors (DOACs) have emerged as potential alternatives in the management of patients with cancer-associated VTE, albeit fi ndings from randomized controlled studies with a direct head-tohead comparison of DOACs with LMWH, the current standard of care, are still lacking. Based on the case of a lymphoma patient experiencing symptomatic pulmonary embolism during immunochemotherapy, this article aims at both highlighting the current state-of-the-art approach to cancer-associated VTE and pointing out some of the unresolved, controversial issues clinicians have to face when taking care of haematology and oncology patients with already established or with high risk of developing VTE. These issues include the management of patients with incidental pulmonary embolism or thrombocytopenia, the use of DOACs, and the initiation of pharmacological thromboprophylaxis in non-surgical cancer patients.

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Dose escalation of low molecular weight heparin in patients with recurrent cancer-associated thrombosis

Cited by 58 publications

References 16 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

Managing thrombosis in cancer patients

Management of cancer-associated venous thromboembolism – a case-based practical approach

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