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Canadian consensus recommendations on the management of venous thromboembolism in
patients with cancer Part 2: treatment
#MMPMID25908913
Easaw JC
; Shea-Budgell MA
; Wu CM
; Czaykowski PM
; Kassis J
; Kuehl B
; Lim HJ
; MacNeil M
; Martinusen D
; McFarlane PA
; Meek E
; Moodley O
; Shivakumar S
; Tagalakis V
; Welch S
; Kavan P
Curr Oncol
2015[Apr]; 22
(2
): 144-55
PMID25908913
show ga
Patients with cancer are at increased risk of venous thromboembolism (vte).
Anticoagulation therapy is used to treat vte; however, patients with cancer have
unique clinical circumstances that can often make decisions surrounding the
administration of therapeutic anticoagulation complicated. No national Canadian
guidelines on the management of established cancer-associated thrombosis have
been published. We therefore aimed to develop a consensus-based,
evidence-informed guideline on the topic. PubMed was searched for clinical trials
and meta-analyses published between 2002 and 2013. Reference lists of key
articles were hand-searched for additional publications. Content experts from
across Canada were assembled to review the evidence and make recommendations. Low
molecular weight heparin is the treatment of choice for cancer patients with
established vte. Direct oral anticoagulants are not recommended for the treatment
of vte at this time. Specific clinical scenarios, including the presence of an
indwelling venous catheter, renal insufficiency, and thrombocytopenia, warrant
modifications in the therapeutic administration of anticoagulation therapy.
Patients with recurrent vte should receive extended (>3 months) anticoagulant
therapy. Incidental vte should generally be treated in the same manner as
symptomatic vte. There is no evidence to support the monitoring of anti-factor Xa
levels in clinically stable cancer patients receiving prophylactic
anticoagulation; however, levels of anti-factor Xa could be checked at baseline
and periodically thereafter in patients with renal insufficiency. Follow-up and
education about the signs and symptoms of vte are important components of ongoing
patient care.
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