Abstract
Background
Prevention of venous thromboembolism (VTE) in cancer patients remains controversial
in most clinical settings.
Purpose
The Italian Society for Haemostasis and Thrombosis (SISET) commissioned a project
to develop clinical practice guidelines for the prevention of VTE in patients with
malignancy.
Methods
Key questions concerning the prevention of VTE in patients with malignancy were formulated
by a multidisciplinary working group consisting of experts in clinical medicine and
research. After a systematic review and discussion of the literature, recommendations
were formulated and graded according to the supporting evidence. For those questions
for which the literature search did not find any definitive answers (due to absence
of evidence, low quality evidence and/or contradictory evidence), a formal consensus
method was used instead to issue clinical recommendations.
Results
The search for “VTE prevention” resulted in 1021 citations; 69 articles were selected
and 24 were used for drafting clinical recommendations. Four areas were graded A to
C: 1) Need of prevention (pharmacological and/or mechanical) in cancer patients undergoing
major abdominal or pelvic surgery and in 2) those with an acute medical disease requiring
hospitalization and who are bedridden. Avoid prevention in 3) cancer patients with
a central venous catheter and 4) those on chemotherapy, radiotherapy or hormonal therapy,
except patients with multiple myeloma treated with thalidomide/lenalidomide plus high-dose
dexamethasone, and those with gastrointestinal or lung cancer. Six areas were considered
to be clinically important, but lacked evidence from the literature and thus required
a formal consensus (grade D): 1) need of prevention during chemo- radiotherapy or
hormonal therapy in patients with previous VTE; 2) optimal duration of pharmacological
prevention in patients who are hospitalized/bedridden for acute medical illness; 3)
optimal duration of pharmacological prevention in patients undergoing major surgery
other than abdominal and pelvic; 4) optimal duration of pharmacological prevention
in myeloma patients receiving thalidomide plus dexamethasone; 5) presence of cerebral
metastasis as a contraindication to pharmacological prevention; 6) prevention in cancer
patients undergoing surgery by laparoscopic procedures lasting>30 min.
Conclusion
Results of the systematic literature review and an explicit approach to consensus
techniques have led to recommendations for the most clinically important issues in
the prevention of VTE in cancer patients.
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References
- Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study.J Thromb Haemost. 2006; 4: 529-535
- Incidence of venous thromboembolism and its effect on survival among patients with common cancers.Arch Intern Med. 2006; 166: 458-464
- Dysregulation of hemostasis by cancer.Cancer Treat Res. 2009; 148: 3-15
- Microparticles, thrombosis and cancer.Best Pract Res Clin Haematol. 2009 Mar; 22: 61-69
- Thrombophilia and cancer.Pathophysiol Haemost Thromb. 2008; 36: 131-136
- Variation in relative risk of venous thromboembolism in different cancers.Thromb Haemost. 2002; 87: 1076-1077
- Thromboembolism in hospitalized neutropenic cancer patients.J Clin Oncol. 2006; 24: 484-490
- Incidence of venous thromboembolism in patients hospitalized with cancer.Am J Med. 2006; 119: 60-68
- Chemotherapy-induced thrombosis.Thromb Res. 2006; 118: 555-568
- A clinical outcome based prospective study on venous thromboembolism after cancer surgery: the ARISTOS project.Ann Surg. 2006; 243: 89-95
- Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer.J Clin Oncol. 2006; 24: 1404-1408
- Anticoagulation for thrombosis prophylaxis in cancer patients with central venous catheters.Cochrane Database Syst Rev. 2007 Jul; 18
- Objectives and methodology: Guidelines of the Italian Society for Haemostasis and Thrombosis.Thromb Res. 2009; 124: e1-e5
Scottish Intercollegiate Guidelines Network, SIGN 50: A guideline developers' handbook, SIGN Publication No. 50. February 2001, last updated May 2004. Available from: http://www.sign.ac.uk.
- A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients: Prophylaxis in Medical Patients with Enoxaparin Study Group.N Engl J Med. 1999; 341: 793-800
- Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients.Circulation. 2004; 110: 874-879
- Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: Randomised placebo controlled trial.BMJ. 2006; 332: 325-329
- Prevention of venous thromboembolism in medical patients with enoxaparin: A subgroup analysis of the MEDENOX study.Blood Coagul Fibrinolysis. 2003; 14: 341-346
- Randomised, controlled trial of low-dose heparin for prevention of fatal pulmonary embolism in patients with infectious diseases: The Heparin Prophylaxis Study Group.Lancet. 1996; 347: 1357-1361
- Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecularweight heparins: A meta-analysis of randomised clinical trials.Thromb Haemost. 2000; 83: 14-19
- National Comprehensive Cancer Network. Venous thromboembolic disease. NCCN. Clinical practice guidelines in oncology.J Natl Compr Canc Netw. 2008 Sep; 6: 716-753
- Venous thromboembolism in cancer patients: ESMO Clinical Practice Guidelines for the management.Ann Oncol. 2010; 21: v274-v276
- working group AIOM. Venous thromboembolism and cancer: guidelines of the Italian Association of Medical Oncology (AIOM).Crit Rev Oncol Hematol. 2006; 59: 194-204
- American Society of Clinical Oncology. American Society of Clinical Oncology. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer.J Clin Oncol. 2007; 25: 5490-5505
- Prevention of Venous Thromboembolism. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).Chest. 2008; 133: 381-453
- Thromboprophylaxis in malignant disease.Br J Surg. 1995; 82: 724-725
- A systematic review of deep venous thrombosis prophylaxis in surgical oncology.Am J Hematol Oncol. 2007; 6: 446-450
- Randomized clinical trial of postoperative fondaparinux versus perioperative dalteparin for prevention of venous thromboembolism in high-risk abdominal surgery.Br J Surg. 2005; 92: 1212-1220
- Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer.New Engl J Med. 2002; 346: 975-980
- Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: A multicenter randomized open-label study.J Thromb Haemost. 2006; 4: 2384-2390
- Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy.Eur Urol. 2008 Jan; 53: 134-145
- Prevention of venous thromboembolism in general surgical patients: Results of meta-analysis.Ann Surg. 1998; 208: 227-240
- Heparins and mechanical methods for thromboprophylaxis in colorectal surgery.Cochrane Database Syst Rev. 2003; 4: CD001217
- Double-blind randomized trial of very-low-dose warfarin for prevention of thromboembolism in stage IV breast cancer.Lancet. 1994; 343: 886-889
- Prevention of venous thromboembolism with low-molecular-weight heparin in patients with metastatic breast or lung cancer: Results of the TOPIC Studies.J Thromb Haemost. 2005; 3 (abstr OR059)
- Deep vein thrombosis in patients with multiple myeloma receiving first-line thalidomide-dexamethasone therapy.Blood. 2002; 100: 2272-2273
- Eastern Cooperative Oncology Group. Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: A clinical trial coordinated by the Eastern Cooperative Oncology Group.J Clin Oncol. 2006; 24: 431-436
- Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy.Blood. 2001; 98: 1614-1615
- Thalidomide- and lenalidomide-associated thromboembolism among patients with cancer.JAMA. 2006; 296: 2558-2560
- Thalidomide and thrombosis: a meta-analysis.Thromb Haemost. 2007; 97: 1031-1036
- Enoxaparin or aspirin for the prevention of recurrent thromboembolism in newly diagnosed myeloma patients treated with melphalan and prednisone plus thalidomide or lenalidomide.J Thromb Haemost. 2006; 4: 1842-1845
- A Phase III Study of Enoxaparin vs Aspirin vs Low-Dose Warfarin as Thromboprophylaxis for Newly Diagnosed Myeloma Patients Treated with Thalidomide Based-Regimens.Blood. 2009; 114: 492
- Deep vein thrombosis in patients with multiple myeloma treated with thalidomide and chemotherapy: effects of prophylactic and therapeutic anticoagulation.Br J Haematol. 2004; 126: 715-721
- Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma.Blood. 2005; 106: 4050-4053
- A Phase III Study of Enoxaparin Vs Aspirin as Thromboprophylaxis for Newly Diagnosed Myeloma Patients Treated with Lenalidomide-Based Regimen.Blood. 2010; 116: 1092
- Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study.Lancet Oncol. 2009; 10: 943-949
- Risk factors for catheter-related thrombosis in cancer patients.Eur J Cancer. 2004; 40: 2253-2259
- Central venous catheter-related complications in patients with hematological malignancies: a retrospective analysis of risk factors and prophylactic measures.Leuk Lymphoma. 2003; 44: 1495-1501
- Prevention of central venous line-related thrombosis by continuous infusion of low-dose unfractionated heparin, in patients with haemato-oncological disease. A randomized controlled trial.Thromb Haemost. 2004; 92: 654-661
- Dalteparin for prevention of catheter-related complications in cancer patients with central venous catheters: Final results of a double-blind, placebo-controlled phase III trial.Ann Oncol. 2006; 17: 289-296
- Prevention of catheter-related venous thrombosis with nadroparin in patients receiving chemotherapy for hematologic malignancies: A randomized, placebo-controlled study.J Thromb Haemost. 2007; 5: 1878-1882
- Systemic anticoagulant prophylaxis for central catheter-associated venous thrombosis in cancer patients.Ann Pharmacother. 2007; 41: 635-641
- French National Feberation of Cancer Centers. 2008 SOR guidelines for the prevention and treatment of thrombosis associated with central venous catheters in patients with cancer: report from the working group.Ann Oncol. 2009 Sep; 20: 1459-1471
Article info
Publication history
Published online: October 03, 2011
Accepted:
September 8,
2011
Received in revised form:
September 6,
2011
Received:
May 29,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
