Abstract
Management of anticoagulant therapy for the treatment of venous thromboembolism (vte) in cancer patients is complex because of an increased risk of recurrent vte and major bleeding complications in those patients relative to the general population. Subgroups of patients with cancer also show variation in their risk for recurrent vte and adverse bleeding events. Accordingly, a committee of 10 Canadian clinical experts developed the consensus risk- stratification treatment algorithm presented here to provide guidance on tailoring anticoagulant treatment choices for the acute and extended treatment of symptomatic and incidental vte, to prevent recurrent vte, and to minimize the bleeding risk in patients with cancer. During a 1-day live meeting, a systematic review of the literature was performed, and a draft treatment algorithm was developed. The treatment algorithm was refined through the use of a Web-based platform and a series of online teleconferences. Clinicians using this treatment algorithm should consider the bleeding risk, the type of cancer, and the potential for drug-drug interactions in addition to informed patient preference in determining the most appropriate treatment for patients with cancer-associated thrombosis. Anticoagulant therapy should be regularly reassessed as the patient's cancer status and management change over time.
Highlights
Venous thromboembolism is common in cancer patients, who have a risk of vte that is increased by a factor of 4 compared with the general population, and for whom vte is the 2nd leading cause of death after cancer progression[1,2]
The draft treatment algorithm was revised based on the resulting feedback and was finalized during a series of Web-based teleconferences held during April and May 2018, during which committee members discussed the treatment algorithm and voted to indicate their level of agreement with both the overall treatment algorithm and with specific changes made to the draft treatment algorithm
According to the treatment algorithm, patients considered to be at high risk of bleeding, those with active gastrointestinal or urothelial cancer, or those taking concomitant medications that would lead to potentially serious drug–drug interactions with doacs should be treated with a therapeutic dose of extended-duration lmwh
Summary
Venous thromboembolism (vte) is common in cancer patients, who have a risk of vte that is increased by a factor of 4 compared with the general population, and for whom vte is the 2nd leading cause of death after cancer progression[1,2]. Because of an increased risk of recurrent vte and major bleeding relative to the general population, the management of anticoagulant therapy for vte in the cancer-patient population is complex[3,4]. Treatment choices for the acute and extended treatment of vte have to be tailored to prevent recurrence of vte and to minimize the bleeding risk in patients with cancer. Based on the results of trials comparing lmwh with vka in the cancer-patient population, current clinical practice guidelines suggest using lmwh monotherapy for the acute and extended treatment of cancer-associated thrombosis (cat)[5,6]. The consensus process reported here was undertaken to develop an evidence-based risk-stratification treatment algorithm and to provide expert guidance about anticoagulation to health care professionals caring for patients with cat
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