International guidelines for antithrombotics in cancer patients.

Abstract

e13062 Background: Venous thromboembolism (VTE), defined as deep-vein thrombosis (DVT) or pulmonary embolism (PE), including those related to indwelling central venous catheter (CVCT), is reported in 15 to 20% of patients with cancer. To date, VTE impact on oncology patients remains elusive and the increased incidence of cancers and of CVC for chemotherapy leads to an increased number of VTE. Methods: Heterogeneity in clinical practices worldwide, and lack of international recommendations led us to establish international guidelines for the management of VTE in cancer patients according to the GRADE methodology. These international guidelines were elaborated under the auspices of the International Society of Thrombosis and Haemostasis (ISTH) following an initiative from the “Groupe Francophone Thrombose et Cancer” (GFTC,www.thrombose-cancer.com) with the collaboration of the Academic Medical Centre (AMC), Amsterdam, The Netherlands, and the methodological support and quality control of the French national cancer institute (INCa). A literature review of the studies published on this topic between 1996 and 2011 was performed. A first version of the guidelines was established based on the corresponding levels of evidence derived from analysis of the selected studies. The recommendations were classified as Strong or Weak according to GRADE and Best Clinical Practices based on international expert’ agreement in the absence of literature data. In the absence of data we provided guidance based on experts opinion. The document was then peer-reviewed by a group of 200 international independent experts. Results: The main topics of the guidelines are the treatment and the prophylaxis of VTE with heparins and vitamin K antagonists in medical and surgical cancer patients, including CVC related thrombosis. Recommendations on the use of vena cava filters, thrombolysis and VTE treatment in patients with intracranial malignancies as well as for prophylaxis in the ambulatory setting are also proposed. Conclusions: These first international guidelines, the methodological steps, the data analysis and critical appraisal, the conclusions with their levels of evidence and the argued judgement of the experts will be available on the GTC, INCa and ISTH web sites