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Clinical Summary

Unmet needs in prophylaxis and treatment of VTE in cancer and critically ill patients

Takeaway

  • Using gap analysis, researchers have identified several unmet needs in the thromboprophylaxis and treatment of venous thromboembolism (VTE) in two high-risk populations, i.e. patients with cancer and patients who are critically ill.
  • The analysis found inadequacies in the VTE risk assessment tools, stratification of patients, thromboprophylaxis strategies and suboptimal utilisation of anticoagulants for primary prophylaxis and treatment.

Why this matters

  • Clinical management of VTE in patients with cancer and the critically ill is challenging as they carry an elevated risk for thrombosis and/or bleeding complications.
  • Adherence to clinical practice guidelines on the prevention and treatment of VTE by healthcare professionals remains suboptimal.
  • Furthermore, there are discrepancies between guideline recommendations due to insufficient evidence and discordance between expert opinions.

Study design

  • A gap analysis methodology was performed which involved interviews with 44 global experts in thrombosis and haemostasis, and a review of practice guidelines and prominent studies to corroborate the experts' insights.
  • Another group of experts met at the 'Thrombosis Think Tank', Paris in February 2018 to evaluate the research findings and provide further insights into two patient populations, cancer and critically ill.
  • Funding: None disclosed.

Key highlights

  • Despite improvements in cancer survival rates, VTE incidence remains high and is a major contributor to mortality in this patient population.
  • Development of pragmatic and useful risk assessment tools is urgently needed to stratify patients with cancer as high-risk, intermediate-risk and low-risk for primary and recurrent VTE, for receiving targeted thromboprophylaxis strategies.
  • Cancer site, stage of the disease and anticancer treatments administered should be considered when selecting an optimal anticoagulant and its dosage for secondary prevention of VTE.
  • VTE is a common cause of preventable morbidity and mortality in acutely ill patients who are hospitalised.
  • Data available on the validity of risk scores for determining the risk level of VTE in critically ill patients are inadequate.
  • No clear recommendations on identifying critically ill patients at risk or management of asymptomatic VTE.
  • Low-molecular-weight heparin remains the first choice of thromboprophylaxis in critically ill patients and those with cancer.
  • The risk for VTE extends beyond the hospital stay in both critically ill patients and those with cancer, hence careful consideration of out-of-hospital thromboprophylaxis is advisable based on the patient’s benefit-to-risk profile.

References


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