Adherence to treatment guidelines for cancer-associated thrombosis: a French hospital-based cohort study

Abstract

Adherence to guidelines appears insufficient since only half of patients received an appropriate treatment. Adherence dropped significantly across treatment periods T2 and T3. VTE diagnosis and cancer characteristics influenced the anticoagulant prescription. Management of patients with CAT requires further education and information of health care professionals.

Factors influencing adherence to clinical guidelines in the management of cancer‐associated thrombosis

“…The prescription of long‐term LMWH does not necessarily imply adherence to treatment guidelines. Indeed, in a hospital‐based cohort of 204 patients with CAT, 63% received long‐term LMWH for at least 3 months, but the treatment adhered to guidelines in only 31% of patients, mainly as a result of the prescription of a molecule other than LMWH in the absence of severe renal insufficiency, the prescription of an anticoagulant other than VKA (45.3%), and inappropriate doses (46.2%) . Several factors may justify deviation from guidelines, including dose adjustments in specific circumstances, such as supportive care, concomitant surgery or biopsy and active bleeding.…”

“…Several factors may justify deviation from guidelines, including dose adjustments in specific circumstances, such as supportive care, concomitant surgery or biopsy and active bleeding. However, this at best only accounts for 34% of inappropriate dosing regimens . In the observational study TROPIQUE, poor clinical condition (3‐4 ECOG index) and a history of recent bleeding were associated with non‐adherence to treatment guidelines because of the need to adapt the LMWH injection schedule .…”

“…In the above‐mentioned hospital‐based cohort study in 204 patients with CAT, the management of patients with metastatic cancer was more often in adherence with treatment guidelines compared with patients without metastases [hazard ratio, HR 2.33 (95% CI 1.31–4.14), P = 0.004]. Also, patients who experienced PE were more often adequately treated than patients with DVT (60% vs. 40%, P = 0.016) . Data from the RIETE registry have shown that metastatic cancer and PE are associated with an appropriate anticoagulant treatment prescription [OR 3.22 (95% CI 2.9–3.6) and OR 1.2 (95% CI 1.0–1.3), respectively] .…”

Management of venous thromboembolism in cancer patients: the economic burden of hospitalizations

“…The implications of our results are numerous. It is of utmost importance to improve the guidelines implementation in patients with VTE and cancer to reduce the risk of recurrence and also the duration of stay at hospital [25]. The ambulatory management of VTE in patients with cancer should be encouraged, especially in patients who have other frequent reasons to be hospitalized.…”

Prophylaxis and Treatment of Cancer-Associated Venous Thromboembolism - Comparison Hematologist/ Oncologists versus Angiologist/Phlebologists

“…Despite these recommendations, several studies indicate that the impact of VTE guidelines on clinical practice is limited [8,9]. We recently published a survey among physicians who treat cancer patients, which showed several deviations, in particular that hospitalized cancer patients often do not receive VTE prophylaxis and many cancer patients with established VTE receive VKAs or NOACs [1].…”