PMID- 23217107
OWN - NLM
STAT- MEDLINE
DCOM- 20130726
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7836 (Linking)
VI  - 11
IP  - 1
DP  - 2013 Jan
TI  - International clinical practice guidelines for the treatment and prophylaxis of 
      venous thromboembolism in patients with cancer.
PG  - 56-70
LID - 10.1111/jth.12070 [doi]
AB  - BACKGROUND:  Guidelines addressing the management of venous thromboembolism (VTE) 
      in cancer patients are heterogeneous and their implementation has been suboptimal 
      worldwide. OBJECTIVES: To establish a common international consensus addressing 
      practical, clinically relevant questions in this setting. METHODS: An 
      international consensus working group of experts was set up to develop guidelines 
      according to an evidence-based medicine approach, using the GRADE system. 
      RESULTS: For the initial treatment of established VTE: low-molecular-weight 
      heparin (LMWH) is recommended [1B]; fondaparinux and unfractionated heparin (UFH) 
      can be also used [2D]; thrombolysis may only be considered on a case-by-case 
      basis [Best clinical practice (Guidance)]; vena cava filters (VCF) may be 
      considered if contraindication to anticoagulation or pulmonary embolism 
      recurrence under optimal anticoagulation; periodic reassessment of 
      contraindications to anticoagulation is recommended and anticoagulation should be 
      resumed when safe; VCF are not recommended for primary VTE prophylaxis in cancer 
      patients [Guidance]. For the early maintenance (10 days to 3 months) and 
      long-term (beyond 3 months) treatment of established VTE, LMWH for a minimum of 3 
      months is preferred over vitamin K antagonists (VKA) [1A]; idraparinux is not 
      recommended [2C]; after 3-6 months, LMWH or VKA continuation should be based on 
      individual evaluation of the benefit-risk ratio, tolerability, patient preference 
      and cancer activity [Guidance]. For the treatment of VTE recurrence in cancer 
      patients under anticoagulation, three options can be considered: (i) switch from 
      VKA to LMWH when treated with VKA; (ii) increase in LMWH dose when treated with 
      LMWH, and (iii) VCF insertion [Guidance]. For the prophylaxis of postoperative 
      VTE in surgical cancer patients, use of LMWH o.d. or low dose of UFH t.i.d. is 
      recommended; pharmacological prophylaxis should be started 12-2 h preoperatively 
      and continued for at least 7-10 days; there are no data allowing conclusion that 
      one type of LMWH is superior to another [1A]; there is no evidence to support 
      fondaparinux as an alternative to LMWH [2C]; use of the highest prophylactic dose 
      of LMWH is recommended [1A]; extended prophylaxis (4 weeks) after major 
      laparotomy may be indicated in cancer patients with a high risk of VTE and low 
      risk of bleeding [2B]; the use of LMWH for VTE prevention in cancer patients 
      undergoing laparoscopic surgery may be recommended as for laparotomy [Guidance]; 
      mechanical methods are not recommended as monotherapy except when pharmacological 
      methods are contraindicated [2C]. For the prophylaxis of VTE in hospitalized 
      medical patients with cancer and reduced mobility, we recommend prophylaxis with 
      LMWH, UFH or fondaparinux [1B]; for children and adults with acute lymphocytic 
      leukemia treated with l-asparaginase, depending on local policy and patient 
      characteristics, prophylaxis may be considered in some patients [Guidance]; in 
      patients receiving chemotherapy, prophylaxis is not recommended routinely [1B]; 
      primary pharmacological prophylaxis of VTE may be indicated in patients with 
      locally advanced or metastatic pancreatic [1B] or lung [2B] cancer treated with 
      chemotherapy and having a low risk of bleeding; in patients treated with 
      thalidomide or lenalidomide combined with steroids and/or chemotherapy, VTE 
      prophylaxis is recommended; in this setting, VKA at low or therapeutic doses, 
      LMWH at prophylactic doses and low-dose aspirin have shown similar effects; 
      however, the efficacy of these regimens remains unclear [2C]. Special situations 
      include brain tumors, severe renal failure (CrCl<30 mL min(-1) ), 
      thrombocytopenia and pregnancy. Guidances are provided in these contexts. 
      CONCLUSIONS: Dissemination and implementation of good clinical practice for the 
      management of VTE, the second cause of death in cancer patients, is a major 
      public health priority.
CI  - (c) 2012 International Society on Thrombosis and Haemostasis.
FAU - Farge, D
AU  - Farge D
AD  - Assistance Publique-Hopitaux de Paris, Internal Medicine and Vascular Disease 
      Unit, Saint-Louis Hospital, Paris, France.
FAU - Debourdeau, P
AU  - Debourdeau P
FAU - Beckers, M
AU  - Beckers M
FAU - Baglin, C
AU  - Baglin C
FAU - Bauersachs, R M
AU  - Bauersachs RM
FAU - Brenner, B
AU  - Brenner B
FAU - Brilhante, D
AU  - Brilhante D
FAU - Falanga, A
AU  - Falanga A
FAU - Gerotzafias, G T
AU  - Gerotzafias GT
FAU - Haim, N
AU  - Haim N
FAU - Kakkar, A K
AU  - Kakkar AK
FAU - Khorana, A A
AU  - Khorana AA
FAU - Lecumberri, R
AU  - Lecumberri R
FAU - Mandala, M
AU  - Mandala M
FAU - Marty, M
AU  - Marty M
FAU - Monreal, M
AU  - Monreal M
FAU - Mousa, S A
AU  - Mousa SA
FAU - Noble, S
AU  - Noble S
FAU - Pabinger, I
AU  - Pabinger I
FAU - Prandoni, P
AU  - Prandoni P
FAU - Prins, M H
AU  - Prins MH
FAU - Qari, M H
AU  - Qari MH
FAU - Streiff, M B
AU  - Streiff MB
FAU - Syrigos, K
AU  - Syrigos K
FAU - Bounameaux, H
AU  - Bounameaux H
FAU - Buller, H R
AU  - Buller HR
LA  - eng
PT  - Journal Article
PT  - Practice Guideline
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Fibrinolytic Agents)
SB  - IM
CIN - J Thromb Haemost. 2014 May;12(5):805-7. PMID: 24628812
CIN - Lancet Oncol. 2019 Dec;20(12):e655. PMID: 31797781
CIN - Lancet Oncol. 2019 Dec;20(12):e656. PMID: 31797782
MH  - Antineoplastic Agents/therapeutic use
MH  - Benchmarking
MH  - Consensus
MH  - Cooperative Behavior
MH  - Evidence-Based Medicine
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - International Cooperation
MH  - Neoplasms/blood/*complications/drug therapy
MH  - Patient Selection
MH  - Recurrence
MH  - Risk Assessment
MH  - Risk Factors
MH  - Thrombolytic Therapy
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vena Cava Filters
MH  - Venous Thromboembolism/diagnosis/*drug therapy/etiology/*prevention & control
EDAT- 2012/12/12 06:00
MHDA- 2013/07/28 06:00
CRDT- 2012/12/11 06:00
PHST- 2012/12/11 06:00 [entrez]
PHST- 2012/12/12 06:00 [pubmed]
PHST- 2013/07/28 06:00 [medline]
AID - S1538-7836(22)05262-X [pii]
AID - 10.1111/jth.12070 [doi]
PST - ppublish
SO  - J Thromb Haemost. 2013 Jan;11(1):56-70. doi: 10.1111/jth.12070.