Implementing Thrombosis Guidelines in Cancer Patients: A Review

Abstract

Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients.

High rates of venous thromboembolic events in patients undergoing systemic therapy for urothelial carcinoma: A systematic review and meta-analysis

“…suggests that low levels of guideline implementation may be contributing to heterogeneity of VTE prophylaxis strategies in practice. [17] Poor adherence to prophylaxis guidelines may explain the lack of improvement in VTE rates over time seen in our study.…”

“…In 2004, the American College of Chest Physicians made recommendations for VTE prophylaxis in hospitalized patients though these were not widely implemented. [17] The American Society of Clinical Oncology published guidelines on VTE prophylaxis in cancer patients only recently, in 2013. In contrast, the Italian Association of Medical Oncology published guidelines in 2006, the French National Cancer Institute in 2008, and the US National Comprehensive Cancer Network in 2010.…”

“…In contrast, the Italian Association of Medical Oncology published guidelines in 2006, the French National Cancer Institute in 2008, and the US National Comprehensive Cancer Network in 2010. [17] A systematic review by Farge-Bancel et al . suggests that low levels of guideline implementation may be contributing to heterogeneity of VTE prophylaxis strategies in practice.…”

Recent Advances in the Management of Cancer-Associated Thrombosis: New Hopes but New Challenges

“…In daily practice, adherence to CPG guidelines remains low worldwide [75]. Real-world data indicate that oral anticoagulation with either VKA or DOAC is frequently used.…”

Clinical practice guidelines for prophylaxis of venous thomboembolism in cancer patients

“…Therefore, cancer related-VTE rates have increased over recent years both in the surgical and the medical oncology setting (1). This increase can also be related to: i) the wider use of more effective systemic anticancer drugs, which are also more prothrombotic; ii) the increased number and the long-term use of CV catheters for chemotherapy and supportive care; iii) the aging cancer population with additional non cancer classical VTE risk factors (5).…”