scholarly journals Clinical challenges in patients with cancer-associated thrombosis: Canadian expert consensus recommendations

2014 ◽  
Vol 22 (1) ◽  
pp. 49 ◽  
Author(s):  
M. Carrier ◽  
A. Lazo-Langner ◽  
S. Shivakumar ◽  
V. Tagalakis ◽  
P.L. Gross ◽  
...  
Keyword(s):  
Expert Consensus ◽  
Patients With Cancer ◽  
Consensus Recommendations ◽  
Cancer Associated Thrombosis

scholarly journals Success of Online CME at Improving Knowledge and Confidence Around Guideline-Directed Management of Cancer-Associated Thrombosis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 13-13
Author(s):  
Caroline Padbury ◽  
Margaret Harris ◽  
Michael LaCouture ◽  
Jelena Spyropoulos
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Treatment Guidelines ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
Roundtable Discussion ◽  
Patients With Cancer ◽  
Cancer Associated Thrombosis ◽  
Post Assessment

Title:Success of Online CME at Improving Knowledge and Confidence Around Guideline-Directed Management of Cancer-Associated Thrombosis Study Objectives:Recent guidance statements recommend the use of direct oral anticoagulants (DOACs) as primary thromboprophylaxis in ambulatory patients with cancer who are starting chemotherapy and in patients with cancer and acute venous thromboembolism at low risk of bleeding and no drug-drug interactions.[Farge 2019; Key 2020] Yet, many clinicians lack knowledge and confidence with integrating DOACs into management strategies for patients with cancer in accordance to guideline recommendations.[Cushman 2015; Khorana 2016] We sought to determine if online continuing medical education (CME) could improve the knowledge and confidence of hematologists/oncologists regarding guideline-directed use of DOACs in the management of cancer-associated thrombosis. Methods:This CME intervention comprised of a 30-minute online video-based roundtable discussion among experts in the field of cancer-associated thrombosis management. Responses to 3 multiple-choice, knowledge questions and 1 self-efficacy, 5-point Likert scale confidence question were analyzed using a repeated pairs pre-/post-assessment study design. A chi-square test (P <.05 is considered significant) assessed pre- to post-activity change . The activity launched December 23, 2019, and data were collected through February 24, 2020. Results:In total, 71 Hematologists/Oncologists were included in this study. Overall, there were knowledge and confidence improvements seen among all groups from pre- to post-assessment: 27% of hematologists/oncologists (P<.01) improved at identifying guideline-directed therapy regarding recommended thromboprophylaxis in patients with cancer per guideline recommendations.27% of hematologists/oncologists (P<.01) improved at selecting guideline-appropriate treatment options for cancer-associated thrombosis.44% of hematologists/oncologists had an increase in confidence in managing thrombosis in patients with cancer. Continued educational gaps: 25% of hematologists/oncologists failed to select guideline recommended DOAC therapy for thromboprophylaxis in cancer patients.45% of hematologists/oncologists failed to select guideline recommended DOAC therapy for treatment of thrombosis in cancer patients.66% of hematologists/oncologists still remain at only a rating of 1 to 3 on a scale of 1 to 5 in their confidence managing thrombosis in patients with cancer. Conclusion:This study demonstrates the success of online, CME-accredited, video-based roundtable discussion with experts in the field on significantly improving knowledge and confidence of hematologists/oncologists related to the guideline-recommended use of DOACs in the management of cancer-associated thrombosis. Continued gaps were also identified for future educational targets. Sources of support: Developed through an independent educational grant from Janssen in partnership with the University of Chicago. References: Cushman M, Creager MA. Improving awareness and outcomes related to venous thromboembolism. JAMA. 2015;314(18):1913-4. Farge D, Frere C, Connors JM, et al. 2019 International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. The Lancet Oncology. 2019;20(10):e566-581. Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020 Feb 10;38(5):496-520. Khorana AA, Yannicelli D, McCrae KR, et al. Evaluation of US prescription patterns: are treatment guidelines for cancer-associated venous thromboembolism being followed? Thromb Res. 2016 Sep;145:51-3. Disclosures No relevant conflicts of interest to declare.

scholarly journals Expert consensus recommendations on the cardiogenetic care for patients with thoracic aortic disease and their first-degree relatives

2018 ◽  
Vol 258 ◽  
pp. 243-248 ◽  
Author(s):  
Judith M.A. Verhagen ◽  
Marlies Kempers ◽  
Luc Cozijnsen ◽  
Berto J. Bouma ◽  
Anthonie L. Duijnhouwer ◽  
...  
Keyword(s):  
Aortic Disease ◽  
Expert Consensus ◽  
Thoracic Aortic Disease ◽  
First Degree Relatives ◽  
Consensus Recommendations

scholarly journals Cardiovascular care of the oncology patient during COVID-19: An expert consensus document from the ACC Cardio-Oncology and Imaging Councils

2020 ◽  
Author(s):  
Lauren A Baldassarre ◽  
Eric H Yang ◽  
Richard K Cheng ◽  
Jeanne M DeCara ◽  
Susan Dent ◽  
...  
Keyword(s):  
Multimodality Imaging ◽  
Cardiovascular Complications ◽  
Expert Consensus ◽  
Oncology Patients ◽  
Oncology Patient ◽  
Cancer History ◽  
Patients With Cancer ◽  
Consensus Document ◽  
Increased Risk ◽  
Cardiovascular Care

Abstract In response to the coronavirus disease 2019 (COVID-19) pandemic, The Cardio-Oncology and Imaging Councils of the American College of Cardiology offers recommendations to clinicians regarding the cardiovascular care of cardio-oncology patients in this expert consensus statement. Cardio-oncology patients–individuals with an active or prior cancer history, and with or at risk of cardiovascular disease–are a rapidly growing population, who are both at increased risk of infection by COVID-19 and experiencing severe and/or lethal complications. Recommendations for optimizing screening and monitoring visits to detect cardiac dysfunction are discussed. In addition, judicious use of multimodality imaging and biomarkers are proposed to identify myocardial, valvular, vascular, pericardial involvement in cancer patients. The difficulties of diagnosing the etiology of cardiovascular complications in patients with cancer and COVID-19 are outlined, along with weighing the advantages against risks of exposure, with the modification of existing cardiovascular treatments and cardiotoxicity surveillance in patients with cancer during the COVID-19 pandemic.

scholarly journals How I Manage Cancer-Associated Thrombosis

2020 ◽  
Vol 40 (01) ◽  
pp. 038-046 ◽  
Author(s):  
Florian Moik ◽  
Cihan Ay
Keyword(s):  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Patients With Cancer ◽  
Risk Of Bleeding ◽  
Randomized Controlled ◽  
Concise Review ◽  
Clinical Scenarios ◽  
Cancer Associated Thrombosis ◽  
Catheter Related Thrombosis

AbstractIn this concise review, we discuss some common clinical challenges in the management of patients with cancer-associated venous thromboembolism (VTE), a frequent complication in patients with cancer that increases morbidity and mortality. While direct oral anticoagulants (DOACs) have been established in clinical practice for anticoagulation in patients with VTE without cancer, their efficacy and safety in patients with cancer have not been assessed in randomized controlled trials until recently. The choice of the appropriate anticoagulant agent in the era of DOACs to treat patients with cancer-associated VTE is based on balancing the risk of recurrence against the risk of bleeding, and potential drug–drug interactions. However, the management of patients is challenged by special scenarios such as incidentally diagnosed pulmonary embolism and catheter-related thrombosis, and sometimes complicated by concomitant thrombocytopenia. We provide guidance for management of cancer-associated VTE in different clinical scenarios in a case-based manner and briefly review recent clinical studies and guidelines to explain our approach to management of the cases.

scholarly journals Cancer-associated thrombosis: updates and controversies

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 626-630 ◽  
Author(s):  
Alok A. Khorana
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Clinical Decision ◽  
Low Molecular Weight ◽  
Clinical Settings ◽  
Level Of Evidence ◽  
Patients With Cancer ◽  
Multiple Biomarkers ◽  
Cancer Associated Thrombosis

Abstract Emerging data have enhanced our understanding of cancer-associated thrombosis, a major cause of morbidity and mortality in patients with cancer. This update will focus on recent findings, including the phenomenon of incidental venous thromboembolism (VTE), novel approaches to risk assessment, and the results of randomized clinical trials focusing on prophylaxis of cancer outpatients. Incidental VTE is an important contributor to rates of cancer-associated VTE and, in terms of outcomes, appears to be as consequential for patients as symptomatic VTE. Multiple biomarkers have been studied, with the highest level of evidence for prechemotherapy elevated platelet counts, elevated leukocyte counts, and low hemoglobin. Other candidate biomarkers, including D-dimer and tissue factor, are currently being evaluated. A recently validated risk score for chemotherapy-associated VTE has now been evaluated in more than 10 000 cancer patients in a variety of clinical settings and trials and is ready for clinical use (Level 1 clinical decision rule). Several randomized clinical trials in solid-tumor patients with low-molecular-weight heparins and semuloparin, an ultra-low-molecular-weight heparin, demonstrate clearly that outpatient thromboprophylaxis is feasible, safe, and effective. Selecting the appropriate patients for prophylaxis, however, continues to be a matter of controversy.

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