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Thromb Haemost 2013; 110(05): 959-965
DOI: 10.1160/TH13-05-0414
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

A worldwide survey to assess the current approach to the treatment of patients with cancer and venous thromboembolism

Ankie Kleinjan
1   Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
,
Anita Aggarwal
3   Divisions of Hematology and Oncology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC, USA
5   Department of Medicine, George Washington University, Washington, DC, USA
,
Annemarie van de Geer
1   Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
,
Charles Faselis
4   Department of Medicine, Veterans Affairs Medical Center, Washington, DC, USA
5   Department of Medicine, George Washington University, Washington, DC, USA
,
Harry R. Büller
1   Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
,
Marcello Di Nisio
1   Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
2   Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio University, Chieti, Italy
,
Frederick R. Rickles
3   Divisions of Hematology and Oncology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC, USA
5   Department of Medicine, George Washington University, Washington, DC, USA
,
Pieter Willem Kamphuisen
6   Department of Vascular Medicine, University Hospital Groningen, the Netherlands
› Author Affiliations
Further Information

Publication History

Received: 22 May 2013

Accepted after major revision: 09 July 2013

Publication Date:
04 December 2017 (online)

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Summary

Low-molecular-weight heparin (LWMH) is recommended as the preferred anticoagulant treatment over vitamin K antagonists (VKA) for venous thromboembolism (VTE) in patients with cancer. However, there is uncertainty about the duration and dose of LMWH treatment. Therefore, we designed this multinational survey to assess the current approach to the treatment of patients with cancer and VTE. An electronic survey tool was used to disseminate a survey containing 49 questions on different aspects of the treatment of patients with cancer and VTE, among both thrombosis and non-thrombosis specialists. A total of 229 invitations were sent, and 141 completed the survey (60% of the total). Fifty-eight percent of the respondents were from Europe, 35% from the US and the remaining 7% from other countries. Respondent’s specialties included haematology (23%), oncology (18%), pulmonology (15%) and general internal medicine (15%). LMWH was indicated as the first choice for the long-term treatment by 82% of the respondents, of whom 60% used full therapeutic doses and 40% chose a dose reduction. When continuing anticoagulants after the long-term treatment period, 44% of respondents preferred LMWH, 10% VKA, while the remaining 45% chose per individual patient for either LMWH or VKA. In conclusion, we observed a relatively high observance rate of the guidelines with respect to the use of LMWH for the long-term treatment of VTE in cancer. In contrast, the dose of LMWH and the type of anticoagulant chosen after the initial 3–12 months varied substantially, probably reflecting the limited available evidence.

Keywords

Anticoagulant treatment - venous thrombosis - malignancy

 

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