Practice Patterns for Prophylaxis and Treatment of Venous Thromboembolism in German Cancer Patients

Matzdorff, Axel; Ledig, Bettina; Stüecker, Markus; Riess, Hanno

doi:10.1159/000444734

Cited by 23 publications

(28 citation statements)

References 39 publications

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“…A recent German study exploring physicians' preferences for anticoagulation in CAT suggested oncologists believed the requirement for a patient or carer to administer a LMWH was an important factor in reducing adherence to this drug. 25 Our data directly challenges this perception and supports the assertion that the views of patients should not only be considered, but actively sought out in planning therapies. 26 Moreover, rather than relying on intuition on which to base expectations of patient preferences, the evidence base should be given due consideration.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Nsupporting

confidence: 70%

“…Whilst poor compliance with VTE clinical guidelines is not a new phenomenon, the reasons are not fully understood. 24,25 Specific to CAT, and despite qualitative data to the contrary, there is an ongoing perception that LMWH is unacceptable or burdensome to patients. 16,26,27 Whilst it is important to offer patients a choice in their anticoagulation treatment, it must be with the caveat that such a choice is informed by data and that preferences for certain Figure 1.…”

Section: Discussionmentioning

confidence: 99%

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Assessing patients' anticoagulation preferences for the treatment of cancer-associated thrombosis using conjoint methodology

et al. 2015

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Low molecular weight heparins have demonstrated superiority over coumarins in the extended treatment of cancer-associated thrombosis and are recommended as first-line therapy in clinical guidelines. Non-vitamin K oral antagonists are yet to be evaluated against low molecular weight heparin for this indication. Nevertheless, a perception that patients favor oral anticoagulants over injections may lead to an increased prescribing of warfarin or non-vitamin K oral antagonists despite the evidence gap. There has been no evaluation of cancer patient preferences for anticoagulants and whether such an evidence gap is an acceptable trade-off for patients prescribed orals. We conducted a study to assess what features are most important to CAT patients regarding their choice of anticoagulant. Two modules were applied: Initial in-depth interviews with 9 patients diagnosed with cancer-associated thrombosis, and thereafter quantitative research, where a further 100 patients completed a choice-based-conjoint exercise, where 15 different scenarios were presented to identify the most important attributes of an anticoagulant. Seventy percent of the patients were treated with injected medication (low molecular weight heparin) and 30% with oral medications. Patients most valued an anticoagulant with minimal interference with their cancer treatment (39%), low thrombosis recurrence rate (24%), and low risk of major bleed (19%). Preference for oral administration over injection had moderate importance (13%). The results show that patients prefer an anticoagulant that does not interfere with their cancer treatment, suggesting the primacy of the cancer disease over venous thromboembolism in these patients. Patients also favor efficacy and safety over convenience of route of administration.

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Section: © F E R R a T A S T O R T I F O U N D A T I O Nsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Assessing patients' anticoagulation preferences for the treatment of cancer-associated thrombosis using conjoint methodology

et al. 2015

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“…Although anticoagulation with LMWH for three to six months is the treatment of choice for cancer-associated VTE, up to half of these patients still receive VKA and overall adherence to LMWH over the course of treatment is poor in clinical practice [51][52][53]. Frequent barriers to the guideline concordant long-term use of LMWH are higher treatment costs, deviating preferences of treating physicians, and the burden of daily subcutaneous injections [54].…”

Section: Are Doacs a Therapeutic Option For This Patient?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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“…Predictive biomarkers for VTE in ambulatory cancer patients have been proposed but, the utility of them in gynaecological patients has not been well investigated [28]. Recent data from the Vienna prospective study show that elevated levels of P-selectin are predictive of thrombosis, and elevated D-dimer in addition to prothrombin 1.2 fragments (F1 + 2) are associated with increased risk of VTE in patients receiving chemotherapy [29]. Moreover, a prospective study reported 2.7-fold increase in arterial thrombosis, and a 47-fold increase in the mortality rate from VTE in patient undergoing chemotherapy compared to the general population [15].…”

Section: Treatment-related Riskmentioning

confidence: 99%

Thromboprophylaxis in women undergoing gynecological surgery or assisted reproductive techniques: new advances and challenges

2016

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Venous thromboembolism (VTE) affects 0.1-0.3% people each year. The risk of VTE following gynecological surgery and invasive procedures is well established and presents one of the major challenges in gynecological practice. Moreover, commonly use assisted reproductive techniques (ART) are reported to increase the risk of VTE. Despite continued efforts to reduce its incidence, postoperative VTE remains the second most common perioperative complication and the third most common cause of mortality.Several practice guidelines have been developed regarding prophylaxis and treatment of VTE. However, there is a large inconsistency between the recommendations and the medical practice in various centers. Moreover, prophylaxis in gynecological patients and women undergoing ART should be chosen individually for the patient, taking into account the possible risk factors for VTE and perioperative bleeding complications. Until recently, the percentage of women, who have not received anticoagulant prophylaxis or administrated it inadequately may reach 50%.This paper presents the current recommendations regarding thromboprophylaxis in women undergoing gynecological surgery or assisted reproductive techniques and addresses challenging practical issues in this field.

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Practice Patterns for Prophylaxis and Treatment of Venous Thromboembolism in German Cancer Patients

Cited by 23 publications

References 39 publications

Assessing patients' anticoagulation preferences for the treatment of cancer-associated thrombosis using conjoint methodology

Assessing patients' anticoagulation preferences for the treatment of cancer-associated thrombosis using conjoint methodology

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

Thromboprophylaxis in women undergoing gynecological surgery or assisted reproductive techniques: new advances and challenges

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