Guideline on aspects of cancer‐related venous thrombosis

Abstract

SummaryThe guideline was drafted by a writing group identified by the Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology (BCSH). All the authors are consultants in haematology in the UK. A search was performed of PubMed and Embase using the term 'cancer' combined with 'thrombosis', 'treatment', 'prophylaxis' and 'clinical presentation'. The search covered articles published up until December 2014. Only human studies were included and articles not written in English were excluded. References in recent reviews were also examined. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemostasis and Thrombosis Task Force of the BCSH and the BCSH executive. The guideline was then reviewed by the sounding board of the British Society for Haematology (BSH). This comprises 50 or more members of the BSH who have reviewed the guidance and commented on the content and application to the UK setting. The 'GRADE' system was used to quote levels and grades of evidence, details of which can be found at: http://www.bcshguidelines.com/ BCSH_PROCESS/EVIDENCE_LEVELS_AND_GRADES_OF_ RECOMMENDATION/43_GRADE.html. The objective of this guideline is to provide healthcare professionals with clear guidance on the prevention and management of venous thromboembolism (VTE) in patients with cancer and to advise on an approach to screening for cancer in patients with unprovoked VTE in whom cancer was not initially suspected based on clinical grounds.

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

“…Additional key articles and other clinical practice guidelines 13,[15][16][17]132 on overlapping clinical questions were consulted and included. The search included meta-analyses, systematic reviews, randomised clinical trials, or non-randomised prospective or retrospective studies (in the absence of randomised clinical trials).…”

“…8 The clinical presentation of VTE-defi ned as deep vein thrombosis, pulmonary embolism, or central venous catheter-associated thrombosis-poses major therapeutic challenges that are further complicated by multiple cancer-related risk factors and comorbidities, which infl uence the choice of anticoagulation. [9][10][11][12] Despite the development of national clinical practice guidelines (CPGs) on VTE treatment, [13][14][15][16][17][18] substantial knowledge gaps remain. 19 Preconceptions about patient tolerance and quality of life with the recommended anticoagulants need to be addressed as they hinder global CPG implementation.…”

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

“…The authors reviewed papers on prophylaxis and the treatment of cancer patients using the MEDLINE database from January 1, 1995 to January 31,2016. The analysis covered available randomized trials, prospective and retrospective studies, as well as meta-analysis, systematic reviews, and previously published Polish and foreign guidelines on prophylaxis and the treatment of venous thromboembolism (VTE), including VTE prophylaxis in cancer patients .…”

Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers - Review

“…In the American guidelines (ASCO, NCCN) [19,34] , extended prophylaxis is only recommended in the presence of high thromboembolic risk factors such as residual or advanced cancer, aged 60 or older, obesity, previous history of VTE, duration of surgery longer than 2 h or prolonged postoperative immobilization. In patients with contraindications to pharmacological anticoagulant prevention strategies (e.g., increased risk of hemorrhage), the use of intermittent pneumatic compression devices or compression stockings is advised [19][20][21][22][23][24][25][26][27] . The recommendations for patients undergoing minimally invasive or laparoscopic surgery are even less evidence-based.…”

“…Recommendations for patients with malignancies are therefore based on the sparse available evidence and the guidelines differ only marginally (Table 2) [19][20][21][22][23][24][25][26][27] . Most clinical studies focusing on VTE in cancer patients do not differentiate between different kinds of cancer, resulting in a lack of specific data concerning VTE in gastrointestinal cancers.…”