Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 2: treatment

  • J.C. Easaw Tom Baker Cancer Centre
  • M.A. Shea-Budgell Tom Baker Cancer Centre
  • C.M.J. Wu University of Alberta
  • P.M. Czaykowski Cancer Care Manitoba
  • J. Kassis Hôpital Maisonneuve–Rosemont
  • B. Kuehl Scientific Insights Consulting Group
  • H.J. Lim BC Cancer Agency
  • M. MacNeil Dalhousie University
  • D. Martinusen University of British Columbia and Royal Jubilee Hospital
  • P.A. McFarlane University of Toronto
  • E. Meek Alberta Health Services
  • O. Moodley University of Saskatchewan
  • S. Shivakumar Dalhousie University and Capital District Health Authority
  • V. Tagalakis Jewish General Hospital
  • S. Welch Western University
  • P. Kavan McGill University
Keywords: low molecular weight heparin, venous thromboembolism, pulmonary embolism, deep vein thrombosis, clots, anticoagulation, practice guideline

Abstract

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.


Author Biography

M.A. Shea-Budgell, Tom Baker Cancer Centre
Melissa Shea-Budgell is the Assistant Scientific Director of the Cancer Strategic Clinical Network at Alberta Health Services and an adjunct lecturer with the Department of Oncology at the University of Calgary.
Published
2015-02-20
How to Cite
Easaw, J., Shea-Budgell, M., Wu, C., Czaykowski, P., Kassis, J., Kuehl, B., Lim, H., MacNeil, M., Martinusen, D., McFarlane, P., Meek, E., Moodley, O., Shivakumar, S., Tagalakis, V., Welch, S., & Kavan, P. (2015). Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 2: treatment. Current Oncology, 22(2), 144-155. https://doi.org/10.3747/co.22.2587
Section
Practice Guideline