scholarly journals International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

2013 ◽  
Vol 11 (1) ◽  
pp. 56-70 ◽  
Author(s):  
D. FARGE ◽  
P. DEBOURDEAU ◽  
M. BECKERS ◽  
C. BAGLIN ◽  
R. M. BAUERSACHS ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Patients With Cancer

scholarly journals Accredited Interactive Web-Based Application for the 2016 International Clinical Practice Guidelines on Thrombosis in Cancer: Improving Knowledge Transfer in Daily Clinical Practice

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5954-5954
Author(s):  
Dominique Farge
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Web Based ◽  
Patients With Cancer ◽  
The Impact

Abstract Venous thromboembolism (VTE) is a major therapeutic concern in cancer patients and the leading cause of death after metastasis. Providing anticoagulant therapy to this patient population is challenging because cancer patients are at increased risk of VTE recurrence and bleeding, and treatment management is often complicated by other co-morbidities that affect choice of anticoagulation. The International Initiative on Thrombosis and Cancer (ITAC-CME) is a multidisciplinary group of International academic clinicians, researchers, and experts dedicated to reducing the global burden of VTE and its consequences in cancer patients. In 2013, the group published international clinical practice guidelines for the treatment and prophylaxis of VTE in cancer (1, 2). In collaboration with CME solutions, an accredited CME provider, ITAC-CME developed a mobile web-based application to promote the international implementation of the 2013 guidelines, in English and French (www.itacc-cme.org). Usage of the app has steadily increased every year since its release. ITAC-CME recently revised its consensus recommendations according to a systematic review of the literature up to January 2016. In particular, the ISTH-endorsed updated recommendations provide a guidance on the use of the direct oral anticoagulants based on the current level of evidence (3). ITAC-CME and CME solutions have updated the web-based application to support the 2016 guidelines. The app also includes several new features, including interactive case-based CME learning activities, with pre- and post-activity practice assessments. These pre- and post-test metrics will be documented to record international clinical practice patterns, and monitor the impact of the app on the adoption of the 2016 guidelines into clinical practice worldwide. Translation of the 2016 updated app into additional languages is planned. The application has been submitted for accreditation with the royal College of Physicians and surgeons of Canada, the American Medical Association, the European Union of Medical Specialists, l' Organisme Gestionnaire du Développement Professionnel Continu, and the European Board for Accreditation in Hematology. 1 Debourdeau P, Farge D, Beckers M, Baglin C, Bauersachs RM, Brenner B, Brilhante D, Falanga A, Gerotzafias GT, Haim N, Kakkar AK, Khorana AA, Lecumberri R, Mandala M, Marty M, Monreal M, Mousa SA, Noble S, Pabinger I, Prandoni P, Prins MH, Qari MH, Streiff MB, Syrigos K, Büller HR, Bounameaux H. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost. 2013 Jan;11(1):71-80. 2 Farge D, Debourdeau P, Beckers M, Baglin C, Bauersachs RM, Brenner B, Brilhante D, Falanga A, Gerotzafias GT, Haim N, Kakkar AK, Khorana AA, Lecumberri R, Mandala M, Marty M, Monreal M, Mousa SA, Noble S, Pabinger I, Prandoni P, Prins MH, Qari MH, Streiff MB, Syrigos K, Bounameaux H, Büller HR. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer.J Thromb Haemost. 2013 Jan;11(1):56-70 3 Farge D, Bounameaux H , Brenner B, Cajfinger F, Debourdeau P, Khorana AA, Pabinger I, Solymoss S, Douketis J, Kakkar A. 2016 International Clinical Practice Guidelines Including Guidance for the Direct Oral Anticoagulants in the Treatment and Prophylaxis of Venous Thromboembolism in Patients With Cancer. Lancet Onccology 2016 (in press) Disclosures No relevant conflicts of interest to declare.

scholarly journals Evaluating the Need for Anticoagulation Beyond 6 Months for Patients with Cancer-Associated Venous Thromboembolism: A Retrospect of Real Life (EXTEND Study)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4245-4245
Author(s):  
Martha L Louzada ◽  
Michael J. Kovacs ◽  
Fatimah Al-ani ◽  
Lenicio Siqueira ◽  
Alejandro Lazo-Langner
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Complete Remission ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Recurrence Risk ◽  
Patients With Cancer ◽  
Cancer Associated Thrombosis

Abstract Background: The association between cancer and venous thromboembolism (VTE) has been well documented. In patients with cancer, the risk for a first cancer- associated thrombosis is 5 to 28-fold higher than in non-cancer patients. Current oncology clinical practice guidelines recommend that patients with cancer- associated thrombosis be treated for a minimum of 6 months with low molecular weight heparin (LMWH) provided they do not have any contraindications to anticoagulant therapy. The length of anticoagulation beyond the initial 6 months is controversial due to the absence of clinical trials data. Panel consensus from the ASCO 2013 clinical practice guidelines recommends continuing anticoagulation if malignancy remains active or patient is still on active anticancer treatment. There is clear equipoise in which type of anticoagulation approach, if any, is the best beyond 6 months of anticoagulation for these patients. In this retrospective analysis we sought to evaluate what has been the extended anticoagulation therapy of choice in our thrombosis clinic over the past 5 years and its efficacy in preventing late recurrent venous thromboembolism. Methods: We conducted a single- centre retrospective cohort study (London, Canada) to collect data from adult patients with cancer -associated VTE who received anticoagulation with therapeutic LMWH for at least 6 months. We collected data from January 2008 to December 2013. We included patients 18 years old or older; with any type of active cancer (except basal cell and squamous cell carcinoma of the skin) or stage. Follow up period started at 6 months of anticoagulation and finished at 12 months (total of 6 months of study follow-up), or at time of a recurrent VTE, or death or last follow up in clinic, whichever came first. We used SAS 9.2 to perform the data analysis. Results: In total 417 patients were potentially eligible but 149 fulfilled our inclusion criteria. 78 (52%) were males, median age was 65 (range 25-86). 123 (82.4%) patients had solid tumors and 26 (17.6%) hematological malignancy. Of the patients with solid tumors, 98 (80.3%) had stage III or IV disease. The most frequent primary tumor sites were colorectal (n= 36; 34%), lung (n=29;20%) and pancreas (n= 17; 11%) among others (n= 41). After the first 6 months of anticoagulation, 20 (13%) patients were considered to be in complete remission of their cancer. In total, 45 of 149 (31%) patients discontinued anticoagulant therapy. 64 (43%) remained on full weight-adjusted dose LMWH, 10 (6%) on prophylactic dose, 29 (19%) were switched to warfarin and 1 (1%) to rivaroxaban. Of the 45 patients that discontinued anticoagulation, 7 were considered to be in complete remission. Overall, there were 21 (14%) VTE recurrences after the first 6 months of anticoagulation. 12 (57%) occurred in patients using full dose LMWH. Patients in complete remission had a lower risk for VTE recurrence (OR= 0.31; 95%CI: 0.102 - 0.920; p= 0.0349). Although not statistically significant, there is a trend of high VTE recurrence risk in patients with lung or colon cancer, or stage III/IV and for patients on full doseLMWH (Table). A post-hoc power calculation of our study demonstrated 84% power with a 2-sided alpha of 0.05. Conclusion: Our study demonstrated a significant increased risk for recurrent VTE (14%) in after the firs 6 months of anticoagulation in patients with cancer-associated VTE irrespective of anticoagulation approach. Being in complete remission is significantly associated with a low risk for recurrence. Having lung or colon cancer or advanced stage may increase recurrence risk. Interestingly, patients on full LMWH also showed trend to high VTE recurrence risk. This may reflect a sicker subset of patients with an inherent higher VTE risk. Further prospective trials are warranted to better study the best anticoagulation approach for patients with cancer-associated VTE beyond the first 6 months of anticoagulation. Table. Univariate analysis for the association of VTE recurrence and tunor and patients characteristics Variables OR (95%CI)# P -value Female 0.58 (0.2 - 1.7) 0.321 Warfarin 0.97 (0.3 - 3.1) 0.958 Prophylactic LMWH^ 0.75 (0.09 - 6.3) 0.791 Full LMWH^ 1.56 (0.62 - 3.9) 0.348 Colorectal* 1.69 (0.4 - 6.4) 0.443 Lung* 1.76 (0.4 - 7.0) 0.422 Pancreas* 0.90 (0.15 - 5.5) 0.909 stageIII or IV 1.93 (0.67 - 5.5) 0.223 #odds ratio ( 95% confidence interval) ^ reference: no anticoagulation * reference: hematological cancer Disclosures No relevant conflicts of interest to declare.

scholarly journals 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

2019 ◽  
Vol 20 (10) ◽  
pp. e566-e581 ◽  
Author(s):  
Dominique Farge ◽  
Corinne Frere ◽  
Jean M Connors ◽  
Cihan Ay ◽  
Alok A Khorana ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Patients With Cancer

scholarly journals Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines

2018 ◽  
Vol 29 ◽  
pp. iv96-iv110 ◽  
Author(s):  
M. Aapro ◽  
Y. Beguin ◽  
C. Bokemeyer ◽  
M. Dicato ◽  
P. Gascón ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Iron Deficiency ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Patients With Cancer

scholarly journals A qualitative study of physicians’ perceptions and preferences for implementing Venous Thromboembolism (VTE) clinical practice guidelines informed by the Theoretical Domains Framework (TDF)

2021 ◽  
Author(s):  
Juliana Abboud ◽  
Abir Abdel Rahman ◽  
Niaz Shaikh ◽  
Martin Dempster ◽  
Pauline Adair
Keyword(s):  
Internal Medicine ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Financial Burden ◽  
Theoretical Domains Framework ◽  
Family Influence ◽  
Structured Interviews ◽  
Hospital Policy

Abstract Background This study used the Theoretical Domains Framework to explore the beliefs and perceptions of physicians to influence the uptake of Venous Thromboembolism prevention guidelines.Methods Semi-structured interviews were conducted with a stratified purposive sample of internal medicine physicians in an acute hospital. The interview topic guide was developed using the Theoretical Domains Framework to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. Emerging relevant themes were mapped to TDF domains.Results A total of sixteen medical physicians were interviewed over a six-month period. Nine theoretical domains derived from thirty-three belief statements were identified as relevant to the target behaviour; knowledge (education about the importance of VTE guidelines); beliefs about capabilities (with practice VTE tool easier to implement); beliefs about consequences ( positive consequences in reducing the development of VTE, length of stay, financial burden and support physician decision) and (negative consequence risk of bleeding); reinforcement (recognition and continuous reminders); goals (patient safety goal); environmental context and resources (workload and availability of medications were barriers, VTE coordinator and electronic medical record were enablers); social influences (senior physicians and patient/family influence the VTE practice); behavioural regulation (monitoring and mandatory hospital policy); and nature of the behaviour.Conclusions Using the Theoretical Domains Framework, factors thought to influence the implementation of VTE clinical practice guidelines in the internal medicine department were identified. These factors present theoretically based targets for future interventions.

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