The NCCN Clinical Practice Guidelines on Venous Thromboembolic Disease: Strategies for Improving VTE Prophylaxis in Hospitalized Cancer Patients

Abstract

After completing this course, the reader will be able to:1. Discuss the importance of thromboprophylaxis in hospitalized cancer patients.2. Identify risk factors for cancer-associated thrombosis.3. Identify strategies to improve compliance with prophylaxis recommended by NCCN guidelines.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThe risk for venous thromboembolism (VTE) is high in hospitalized cancer patients, and is associated with an elevated risk for recurrent thrombosis, bleeding complications, and use of health care resources. Thromboembolism is the second leading cause of death in hospitalized cancer patients. Thromboprophylaxis with unfractionated heparin or lowmolecular-weight heparins has been clinically proven to reduce the risk for VTE and improve outcomes. However, VTE prophylaxis continues to be underprescribed in cancer patients. Recognizing the clinical burden of VTE in cancer patients, the National Comprehensive Cancer Network (NCCN) recently released guidelines for VTE prevention and management. These NCCN guidelines recommend evidencebased prophylactic anticoagulant therapy for all patients admitted to hospital with a diagnosis of cancer who do not have contraindications to anticoagulant use. However, there continue to be barriers to the implementation of clinical practice guidelines and appropriate use of VTE prophylaxis. Multifaceted active educational and electronic interventions are necessary to raise awareness and reduce the burden of cancer-associated thrombosis and its attendant consequences.

Impact of Venous Thromboembolism on Mortality of Elderly Medicare Patients with Stage III Colon Cancer

“…Although VTE is a preventable cause of death [19], it remains the leading cause of death in patients with overt malignancy [20], second only to the cancer diagnosis. VTE is the most common cause of 30-day mortality among patients with cancer who undergo surgery [21].…”

Tromboembolismo venoso e câncer colorretal: um desafio para o cirurgião. Relato de caso e revisão de literatura

“…A administração de enoxaparina por quatro semanas reduziu significativamente a incidência de TEV na quarta semana após a operação confirmada por venografia (4,8% vs. 12%). Segundo o National Comprehensive Cancer Network (NCCN), o uso deve ser mantido por quatro semanas, na dose de 40 mg ao dia, no pós-operatório 6 . Apesar da reconhecida importância, a tromboprofilaxia é sistematicamente subutilizada nos hospitais, como exposto em estudo retrospectivo americano em pacientes de risco para TEV.…”

“…Apesar da reconhecida importância, a tromboprofilaxia é sistematicamente subutilizada nos hospitais, como exposto em estudo retrospectivo americano em pacientes de risco para TEV. Esse revelou taxas de profilaxia de apenas 25%, mesmo nos pacientes oncológicos 6 . Essa profilaxia inadequada tem consequên-cias graves e tem sido revista.…”

Cancer-Associated Thrombosis

“…New treatment guidelines from the National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO) accept prophylaxis for VTE in hospitalized cancer patients in the absence of major bleeding or other contraindications to anticoagulants [50,61]. Contraindications to anticoagulation according to ASCO guidelines include uncontrollable bleeding, active cerebrovascular hemorrhage, dissecting or cerebral aneurysm, bacterial endocarditis, active peptic or other gastrointestinal ulceration, severe uncontrolled or malignant hypertension, severe head trauma, pregnancy (warfarin), heparin-induced thrombocytopenia and epidural catheter placement.…”

“…Low-molecular-weight heparin, dalteparin 5000 units s.c daily, enoxaparin 40 mg s.c daily or fondaparinux 2.5 mg s.c daily is recommended for prophylaxis of VTE in patients with cancer [50,61,62]. A randomized clinical trial of combination chemotherapy with LMWH with dalteparin 5000 units once daily for 18 weeks compared to chemotherapy alone in patients with small-cell lung cancer revealed that combination therapy with dalteparin increased disease-free survival (10 months) compared chemotherapy alone (6 months, P=0.01) [63].…”