In the Clinic: Annals Sweta Kakaraparthi 1/23/15
|
|
- Chloe Ross
- 5 years ago
- Views:
Transcription
1 In the Clinic: Annals Sweta Kakaraparthi 1/23/15
2 Case Scenerio 56 year old female with breast cancer presents to the clinic for her 3 month followup! She is concerned about blood clots and asks you about her risk as well as preventive measures! WHAT WOULD YOU DO?
3 Prophylaxis against Thromboembolism in Cancer Patients: In the Clinic
4 Dan L. Longo, M.D., Editor Prophylaxis against Venous Thromboembolism in Ambulatory Patients with Cancer Jean M. Connors, M.D. Tn engl j med 370;26 nejm.org june 26, 2014!! 2013 by American Society of Clinical Oncology! Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update!.! Gary H. Lyman, Alok A. Khorana, Nicole M. Kuderer, Agnes Y. Lee, Juan Ignacio Arcelus, Edward P. Balaban, Jeffrey M. Clarke, Christopher R. Flowers, Charles W. Francis, Leigh E. Gates, Ajay K. Kakkar, Nigel S. Key, Mark N. Levine, Howard A. Liebman, Margaret A. Tempero, Sandra L. Wong, Ann Alexis Prestrud and Anna Falanga! +!
5 Introduction Risk of thromboembolism is 4-7 times higher in cancer patients! Venous Thromboembolism is the second leading cause of death in patients with cancer! Mucin production, Exposure of tissue factor-rich surfaces, local hypoxia, etc.! Prophylactic anticoagulation in patients with cancer: Surgery and Hospitalized patients
6 Risk and Rates of Venous Thromboembolism Risk depends on type of cancer, treatments and presence/absence of coexisting disease! Khorana score! According to this model, 0.3% among low risk patients; 2.0% in intermediate risk patients and 6.7% among high-risk patients over 2.5 month period
7 Table 1. Risk-Assessment Model for Venous Thromboembolism, According to the Khorana Score.* Variable Type of cancer Points Odds Ratio (95% CI) Stomach or pancreatic ( ) Lung, lymphoma, gynecologic, bladder, or testicular ( ) Platelet count 350,000/mm ( ) Hemoglobin <10 g/dl ( ) White-cell count >11,000/mm ( ) BMI ( ) * Data are from Khorana et al. 18 The aggregate score is calculated by adding the individual component points. Complete blood counts before treatment should be used. An aggregate score of 0 indicates low risk, an aggregate score of 1 or 2 indicates intermediate risk, and an aggregate score of 3 or more indicates high risk. The body-mass index (BMI) is the weight in kilograms divided by the square of the height in meters. Odds ratios are based on data from the derivation cohort. CI denotes confidence interval.
8
9 Other risk factors Prolonged immobilization! Use of hormone therapy and angiogenesis inhibitors.! History of deep-vein thrombosis, vascular compression due to tumor or adenopathy,! Known inherited thrombophilia.
10 Introduction: Ambulatory Setting Empiric prophylaxis against venous thromboembolism in ambulatory patients remains controversial
11 Guidelines: ASCO 1. Routine pharmacologic thromboprophylaxis is not recommended in cancer outpatients.!! 2. Based on limited RCT data, clinicians may consider LMWH prophylaxis on a case-by-case basis in highly selected outpatients with solid tumors receiving chemotherapy. Consideration of such therapy should be accompanied by a discussion with the patient about the uncertainty concerning benefits and harms as well as dose and duration of prophylaxis in this setting.!! 3. Patients with multiple myeloma receiving thalidomide- or lenalidomide-based regimens with chemotherapy and/or dexamethasone should receive pharmacologic thromboprophylaxis with either aspirin or LMWH for lower-risk patients and LMWH for higher-risk patients.!
12 Table 2. Comparison of Recommendations Regarding Prophylaxis against Venous Thromboembolism.* Potential Indication Treatment of multiple myeloma with tha lido mide or lenalidomide with high-dose dexamethasone, doxorubicin, combi nation chemotherapy, or other risk factors Cancer associated with high risk of venous thromboembolism (pancreatic or gastric) Recommended Use of Prophylaxis Author ACCP ASCO NCCN Yes Suggest Yes Yes With other risk factors Yes Suggest Consider Consider Without other risk factors Consider No Consider Consider Cancer associated with intermediate risk of venous thromboembolism (lung, ovarian, primary central nervous system, bladder, lymphoma) With other risk factors Consider Suggest Consider No Without other risk factors No No Consider No Cancer associated with low risk of venous thromboembolism With other risk factors Consider Suggest Consider No Without other risk factors No No Consider No * Consensus guidelines of professional societies are not always explicit. Variations in the strength of recommendations exist because data are limited and often recommendations are extrapolated from other patient populations. All societies agree that high-risk patients with multiple myeloma should receive prophylaxis, although the wording of the American College of Chest Physicians (ACCP) is suggest, or a weak recommendation based on limited data. For other patient groups, yes indicates a definitive recommendation; suggest, a weak recommendation; and consider, a possible benefit but with no supporting data and therefore uncertainty regarding benefit. The ACCP 11 suggests the use of prophylaxis in patients with solid tumors, a low bleeding risk, and additional risk factors for venous thromboembolism. According to other societies and clinicians, additional risk factors for venous thromboembolism include previous venous thromboembolism, inherited thrombophilia, the use of hormonal therapy, the presence of metastatic disease, vascular compromise by tumor or lymphadenopathy, and a high Khorana risk score. The Amer i can Society of Clinical Oncology (ASCO) suggests that the use of prophylaxis should be considered on a case-by-case basis in highly selected outpatients who have solid tumors and are receiving chemotherapy, and the uncertainty of risks and benefits should be discussed. The National Comprehensive Cancer Network (NCCN) advises that prophylaxis against venous thromboembolism should not be used outside the setting of a clinical trial, although it can be considered for patients with a Khorana score of 3 or higher. Bleeding risk must be assessed and considered. High-risk factors for bleeding include a recent episode of major active bleeding or bleeding at a critical site, a platelet count of less than 50,000 per cubic millimeter, and the presence of untreated central nervous system metastases. The risk for the individual patient should be assessed, and the risk benefit ratio should be discussed with that patient.
13 Society Guidelines For patients with an increased risk of venous thromoboembolism, such as those with a Khorana score of 3 or higher or patients with pancreatic, lung, or stomach cancer, the ASCO and NCCN guidelines recommend conversations with the individual patient about the risks and benefits of prophylactic anticoagulation! ACCP guidelines recommend the use of prophylactic lowmolecular-weight heparin or unfractionated heparin.!
14 Literature Analysis 3 systematic reviews considering the ambulatory setting and 9 RCTs.! Two RCTs, SAVE-ONCO (Evaluation of AVE5026 in the Prevention of Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy) and PROTECHT (Prophylaxis of Thromboembolism During Chemotherapy) included patients with a variety of solid tumors.! FRAGEM (Gemcitabine With or Without Dalteparin in Treating Patients With Locally Advanced or Metastatic Pancreatic Cancer) and PROSPECT-CONKO 004 (Chemotherapy With or Without Enoxaparin in Pancreatic Cancer) included only patients with pancreatic cancer.! The PRODIGE (Dalteparin Low Molecular Weight Heparin for Primary Prophylaxis of Venous Thromboembolism in Brain Tumour Patients) trial examined anticoagulation for patients with glioma. Two recent trials evaluated thromboprophylaxis in multiple myeloma.
15 Systemic Reviews Two systematic reviews identified RCTs comparing LMWH prophylaxis in the outpatient setting with placebo or no prophylaxis.! Estimated risk ratios (RRs) across trials indicated decreases in symptomatic VTE events with LMWH thromboprophylaxis of 0.53 (95% CI, 0.39 to 0.72) and 0.54 (95% CI, 0.31 to 0.95),! Neither meta-analysis noted a statistically significant increase in bleeding with LMWH! The absolute differences in symptomatic VTE event rates between treated and control patients were < 5% in most trials. Among the three systematic reviews, the absolute risk differences in VTE were 1.5%, 2.8%, and 1.7% with estimates of the number needed to treat (NNT) of 67, 36, and 59 to prevent one symptomatic VTE event across the included trials
16 Clinical Trials: Solid Tumor The PROTECHT and SAVE-ONCO trials evaluated thromboprophylaxis in ambulatory patients with cancer receiving chemotherapy for locally advanced or metastatic solid tumors.! ENDPOINT: composite of symptomatic VTEs and arterial thromboembolic events during treatment and follow-up! In PROTECHT trial, 3.9% of patients in the control arm experienced events compared with 2.0% of patients treated with nadroparin for an NNT of 53. Major bleeding rates were not different between the arms.! In SAVE-ONCO, fewer symptomatic VTE events occurred in patients who received semuloparin (1.2%) compared with placebo (3.4%; HR, 0.36; 95% CI, 0.21 to 0.60; P <.001). The absolute risk difference for VTE events was 2.2% for an NNT of 45. Major bleeding was similar across arms
17 Clinical Trials: Solid Tumors The PROTECHT [Prophylaxis of Thromboembolism during Chemotherapy] study randomly assigned 1150 ambulatory patients with cancer to receive prophylactic nadroparin or placebo.! The SAVE-ONCO trial randomly assigned 3212 ambulatory patients receiving chemotherapy for locally advanced solid tumors or metastatic cancer to receive a prophylactic dose of semuloparin or placebo.
18 Clinical trials: Solid tumors In the PROTECHT trial, the subjects were not separated prospectively according to risk of venous thromboembolism! Clinical trials vs. Real world retrospective analysis
19 Clinical Trials: Solid Tumors Two double-blind RCTs of ambulatory patients with metastatic breast carcinoma (TOPIC-1) or stage III/IV non small-cell lung carcinoma (TOPIC-2) compared certoparin 3,000 IU subcutaneously once daily with placebo for 6 months.! The primary outcome was symptomatic or asymptomatic VTE.
20 Clinical Trials: Pancreatic Cancer FRAGEM and PROSPECT-CONKO trials enrolled patients with advanced pancreatic neoplasms.! The FRAGEM trial was a phase IIb RCT of 123 patients with advanced pancreatic cancer receiving gemcitabine-based chemotherapy comparing thromboprophylaxis with therapeutic doses of dalteparin up to 12 weeks,! VTE over the course of the study was reduced from 28% to 12%, with a relative risk of 0.42 (95% CI, 0.19 to 0.94; P =.039). No differences in rates of major bleeding or mortality between study arms were observed.
21 Glioma The PRODIGE trial included 186 patients with newly diagnosed grade 3 or 4 glioma and was terminated early.! Patients were randomly assigned to dalteparin or placebo for 6 months, and therapy could continue for an additional 6 months.! VTE events occurred in nine patients (9%) in the dalteparin arm compared with 13 patients (15%) in the placebo arm (HR, 0.51; 95% CI, 0.19 to 1.40; P =.29). Five patients in the dalteparin arm experienced intracranial bleeding by 12 months compared with one in the control arm
22
23 Conclusion: Solid Tumors Overall, the Panel concluded that offering all patients with solid malignancies anticoagulation for thromboprophylaxis in the ambulatory setting is not justified based on the available clinical trial data and the heterogeneity of this patient population.
24 Multiple Myeloma Two RCT substudies assessed different thromboprophylaxis strategies in patients with newly diagnosed multiple myeloma receiving lenalidomide- or thalidomide-based treatment! Either enoxaparin (at a dose of 40 mg subcutaneously daily or the equivalent) or warfarin is recommended, although INR targets differ (ASCO guidelines recommend 1.5 and NCCN and ACCP guidelines recommend 2.0 to 3.0).!
25 Bleeding risk Closely monitored, and anticoagulation therapy can be withheld if there are changes in renal function or the platelet count that suggest an increased risk of bleeding.! All guidelines suggest withholding any dose of anticoagulation drug if the platelet count is less than 50,000! However, for very high-risk patients, the continued use of prophylactic anticoagulation therapy can be considered if the platelet count is more than 30,000
26 Conclusion Increased use of prophylaxis against venous thromoboembolism in high-risk ambulatory patients with cancer who are eligible for this therapy could lead to improved outcomes.! Need for further studies
27
28
The risk of venous thromboembolism is four to seven times as
review article Dan L. Longo, M.D., Editor Prophylaxis against Venous Thromboembolism in Ambulatory Patients with Cancer Jean M. Connors, M.D. The risk of venous thromboembolism is four to seven times as
More informationPRIMARY THROMBOPROPHYLAXIS IN AMBULATORY CANCER PATIENTS: CURRENT GUIDELINES
PRIMARY THROMBOPROPHYLAXIS IN AMBULATORY CANCER PATIENTS: CURRENT GUIDELINES Mario Mandalà, MD Unit of Clinical Research Department of Oncology and Haematology Papa Giovanni XXIII Hospital Cancer Center
More informationJ Clin Oncol 31: by American Society of Clinical Oncology INTRODUCTION
VOLUME 31 NUMBER 17 JUNE 10 2013 JOURNAL OF CLINICAL ONCOLOGY A S C O S P E C I A L A R T I C L E Gary H. Lyman, Nicole M. Kuderer, and Jeffrey M. Clarke, Duke University and Duke Cancer Institute, Durham;
More informationProfilassi e trattamento del tromboembolismo venoso nei pazienti con neoplasia: le nuove linee guida
Profilassi e trattamento del tromboembolismo venoso nei pazienti con neoplasia: le nuove linee guida Anna Falanga Dipartimento di Medicina Trasfusionale ed Ematologia Centro Trombosi ed Emostasi Ospedale
More informationCancer and Thrombosis
Cancer and Thrombosis The close relationship between venous thromboembolism and cancer has been known since at least the 19th century by Armand Trousseau. Thrombosis is a major cause of morbidity and mortality
More informationIs There a Role for Prophylaxis in Cancer Patients During Therapy?
Victor F. Tapson, MD, FCCP, FRCP Professor of Medicine Director, Center for Pulmonary Vascular Disease Division of Pulmonary and Critical Care Duke University Medical Center Durham, N.C. USA Is There a
More informationTHROMBOPROPHYLAXIS IN CANCER PATIENTS
CANCER ASSOCIATED THROMBOSIS THROMBOPROPHYLAXIS IN CANCER PATIENTS Cancer is an important risk factor for venous thromboembolism (VTE). Research has shown that 4-20% of 1 patients with cancer experience
More informationTissue Factor-positive Microparticles in Cancerassociated
Tissue Factor-positive Microparticles in Cancerassociated Thrombosis Nigel Mackman, Ph.D., FAHA John C. Parker Distinguished Professor of Medicine Director of the UNC McAllister Heart Institute Co-Director
More informationDVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE)
DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE) Introduction VTE (DVT/PE) is an important complication in hospitalized patients Hospitalization for acute medical illness
More informationThromboprophylaxis for medical patients with cancer: what do the guidelines say?
ith Thromboprophylaxis for medical patients with cancer: what do the guidelines say? Practice Points Hospitalized medically ill cancer patients should receive parenteral thromboprophylaxis for the duration
More informationASH 2011: Clinically Relevant Highlights Regarding Venous Thromboembolism and Anticoagulation
ASH 2011: Clinically Relevant Highlights Regarding Venous Thromboembolism and Anticoagulation Stephan Moll Department of Medicine, Division of Hematology-Oncology, University of North Carolina School of
More informationVenous Thrombo-Embolism. John de Vos Consultant Haematologist RSCH
Venous Thrombo-Embolism John de Vos Consultant Haematologist RSCH overview The statistics Pathogenesis Prophylaxis Treatment Agent Duration Incidental VTE Recurrence of VTE IVC filters CVC related thrombosis
More informationAre guidelines for anticoagulation useful in cancer patients?
Session 3 Striking a Balance Between Bleeding and the Risk of Thrombosis in Cancer Patients Are guidelines for anticoagulation useful in cancer patients? Sebastian Szmit Department of Pulmonary Circulation
More informationManagement of Cancer Associated Thrombosis (CAT) where data is lacking. Tim Nokes Haematologist, Derriford Hospital, Plymouth
Management of Cancer Associated Thrombosis (CAT) where data is lacking Tim Nokes Haematologist, Derriford Hospital, Plymouth Contents Overview of the statistics and aetiology for Cancer Associated Thrombosis
More informationNew Hope for VTE Burden in Ambulatory Cancer Patients
New Hope for VTE Burden in Ambulatory Cancer Patients Essam Abo-El-Nazar MS, FRCS Consultant Liver Surgeon King Fahd Hospital Jeddah-KSA Prof. of Surgery Imperial College London-UK My talk today What is
More informationCANCER ASSOCIATED THROMBOSIS. Pankaj Handa Department of General Medicine Tan Tock Seng Hospital
CANCER ASSOCIATED THROMBOSIS Pankaj Handa Department of General Medicine Tan Tock Seng Hospital My Talk Today 1.Introduction 2. Are All Cancer Patients at Risk of VTE? 3. Should All VTE Patients Be Screened
More informationCancer and the Heparins
Cancer and the Heparins Wim P Ceelen, MD, PhD, FACS Department of GI Surgery - UZ Gent Senior Clinical Researcher - FWO Overview Mechanisms of cancer induced thrombosis Guidelines for prevention and treatment
More informationProphylaxie primaire sur le patient ambulatoire. Marc Carrier
Prophylaxie primaire sur le patient ambulatoire Marc Carrier Marc Carrier In compliance with COI policy, SSVQ requires the following disclosures to the session audience: Research Support/P.I. Employee
More informationCancer Associated Thrombosis: six months and beyond. Farzana Haque Hull York Medical School
Cancer Associated Thrombosis: six months and beyond Farzana Haque Hull York Medical School Disclosure I have no disclosure The Challenge of Anticoagulation in Patients with Venous Thromboembolism and Cancer
More informationCancer-associated thrombosis: updates and controversies
THROMBOSIS IN CHALLENGING POPULATIONS Cancer-associated thrombosis: updates and controversies Alok A. Khorana James P. Wilmot Cancer Center and Department of Medicine, University of Rochester, Rochester,
More informationCancer Associated Thrombosis An update.
Cancer Associated Thrombosis An update. Simon Noble Marie Curie Professor of Supportive and Palliative Medicine Marie Curie Palliative Care Research Centre Cardiff University The coagulation pathway LIQUID
More information10/8/2012. Disclosures. Making Sense of AT9: Review of the 2012 ACCP Antithrombotic Guidelines. Goals and Objectives. Outline
Disclosures Making Sense of AT9: Review of the 2012 ACCP Antithrombotic Guidelines No relevant conflicts of interest related to the topic presented. Cyndy Brocklebank, PharmD, CDE Chronic Disease Management
More informationVenous Thromboembolism (VTE) in Myeloma. Christine Chen May 2017
Venous Thromboembolism (VTE) in Myeloma Christine Chen May 2017 Objectives 1. Review the magnitude of the problem and why myeloma patients are at risk of VTE 2. Discuss thromboprophylaxis approaches in
More informationReport dei gruppi di lavoro >> [ Trombosi e cancro ]
Report dei gruppi di lavoro >> [ Trombosi e cancro ] Relatori: A. FALANGA, M. MARCHETTI 27-28 ottobre 2008 Borgo S. Luigi Monteriggioni (Siena) Trombosi e cancro - Copyright FSE 1 Gruppo di lavoro 2 [
More informationMedical Patients: A Population at Risk
Case Vignette A 68-year-old woman with obesity was admitted to the Medical Service with COPD and pneumonia and was treated with oral corticosteroids, bronchodilators, and antibiotics. She responded well
More informationEpidemiology of Thrombosis in Patients with Malignancy. Cancer and Venous Thromboembolism. Chew HK, Arch Int Med, Feb Blom et al, JAMA, Feb 2005
Cancer and Venous Thromboembolism Objectives 1. Epidemiology of thrombosis in patients with malignancy 2. Anticancer agents and thrombosis 3. Current treatment protocols at UHN 4. Prevention of DVT 5.
More informationLow Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders
SURGICAL GRAND ROUNDS March 17 th, 2007 Low Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders Guillermo Escobar, M.D. LMWH vs UFH Jayer s sales pitch: FALSE LMW is
More informationClinical practice guidelines for prophylaxis of venous thomboembolism in cancer patients
618 Theme Issue Article Clinical practice guidelines for prophylaxis of venous thomboembolism in cancer patients Corinne Frere 1 ; Dominique Farge 2 1 Assistance Publique Hôpitaux de Marseille, Timone
More informationLa terapia del TEV nel paziente oncologico nell'era dei DOAC
XXVI CONGRESSO NAZIONALE FCSA Bologna, 5-7 Novembre 2015 Tromboembolismo venoso La terapia del TEV nel paziente oncologico nell'era dei DOAC ANNA FALANGA Immunoematologia e Medicina Trasfusionale e Centro
More informationProphylaxis for Hospitalized and Non-Hospitalized Medical Patients
Prophylaxis for Hospitalized and Non-Hospitalized Medical Patients An Educational Slide Set American Society of Hematology 2018 Guidelines for Management of Venous Thromboembolism Slide set authors: Eric
More informationNew oral anticoagulants and Palliative Care.
New oral anticoagulants and Palliative Care. Simon Noble Marie Curie Professor of Supportive and Palliative Medicine Marie Curie Palliative Care Research Centre Cardiff University The coagulation pathway
More informationAnticoagulation Therapy in SELECTeD Cancer Patients at Risk of Recurrence of Venous Thromboembolism
Anticoagulation Therapy in SELECTeD Cancer Patients at Risk of Recurrence of Venous Thromboembolism Annie Young PhD Professor of Nursing, University of Warwick, UK on behalf of the select-d Collaborative
More informationThromboembolism and cancer: New practices. Marc Carrier
Thromboembolism and cancer: New practices Marc Carrier Marc Carrier Research Support/P.I. Employee Consultant Major Stockholder Speakers Bureau Honoraria Scientific Advisory Board Leo Pharma, BMS No relevant
More informationFatal P.E. Historic 1-2% Current %
Dr. (Prof.) Anil Arora MS (Ortho) DNB (Ortho) Dip SIROT (USA) FAPOA (Korea), FIGOF (Germany), FJOA (Japan) Commonwealth Fellow Joint Replacement (Royal National Orthopaedic Hospital, London, UK) Senior
More informationCancer Associated Thrombosis
Cancer Associated Thrombosis Pantep Angchaisuksiri, MD Professor of Medicine Mahidol University, Thailand Adjunct Associate Professor University of North Carolina, Chapel Hill, USA Piccioli A. J Thromb
More informationReview Guideline recommendations for the treatment of established VTE Initial treatment (fi rst 10 days) Panel 1:
International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer Dominique Farge, Henri Bounameaux,
More informationUpdate on the Management of Cancer Associated VTE
Update on the Management of Cancer Associated VTE Jean M. Connors, MD 2018 Master Class Course Anticoagulation Management Services BWH/DFCI Hemostatic Antithrombotic Stewardship BWH Associate Professor
More informationDiagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism
Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Diagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism Summary Number 68 Overview Venous thromboembolism
More informationGLIOMA - VENOUS THROMBOEMBOLISM. Miguel Navarro. Hospital Universitario de Salamanca-IBSAL
GLIOMA - VENOUS THROMBOEMBOLISM Miguel Navarro. Hospital Universitario de Salamanca-IBSAL GLIOMA - VTE GLIOMA - VTE The two string problem Substantial risk for developing VTE Concern antithrombotic agents
More informationVenous thrombosis in the patient with cancer
Venous thrombosis in the patient with cancer Wessels PF, MBChB MMed, CertClin Hematology(CMSA) Private Practice, LCM Hospital, Pretoria, and Consultant, Ampath Laboratories Part-Time Consultant, Department
More informationPrevention and management of venous thromboembolism M. AAPRO
Prevention and management of venous thromboembolism M. AAPRO Thromboprophylaxisof DVT and PE in AmbulatoryCancerPatients Zurich, February 2017 M. AAPRO Based on a lesson in April 2016 by M. DICATO M.D.,
More informationEXTENDING VTE PROPHYLAXIS IN ACUTELY ILL MEDICAL PATIENTS
EXTENDING VTE PROPHYLAXIS IN ACUTELY ILL MEDICAL PATIENTS Samuel Z. Goldhaber, MD Director, VTE Research Group Cardiovascular Division Brigham and Women s Hospital Professor of Medicine Harvard Medical
More informationVenous Thromboembolism in Cancer: Role of LMWH and Optimal Duration of Therapy
Venous Thromboembolism in Cancer: Role of LMWH and Optimal Duration of Therapy Craig M Kessler, MD MACP Lombardi Comprehensive Care Center Georgetown University Medical Center Washington, DC COI Financial
More informationManagement of Cancer Associated VTE
Management of Cancer Associated VTE Jean M. Connors, MD 2017 Master Class Course Anticoagulation Management Services BWH/DFCI Hemostatic Antithrombotic Stewardship BWH Assistant Professor of Medicine HMS
More informationPrimary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy (Review)
Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy (Review) Di Nisio M, Porreca E, Otten HM, Rutjes AWS source: https://doi.org/10.7892/boris.59961 downloaded:
More informationRISK FACTORS. Cancer type. Cancer stage
CANCER ASSOCIATED THROMBOSIS RISK FACTORS The link between cancer and thrombosis is well established, with malignancy recognised as the most important individual risk factor for venous thromboembolism
More informationDeep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H
Deep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H Authors' objectives To systematically review the incidence of deep vein
More informationObjectives. Venous Thromboembolism (VTE) Prophylaxis. Case VTE WHY DO IT? Question: Who Is At Risk?
Objectives Venous Thromboembolism (VTE) Prophylaxis Rishi Garg, MD Department of Medicine Identify patients at risk for VTE Options for VTE prophylaxis Current Recommendations (based on The Seventh ACCP
More informationCancer associated thrombosis. 17 th November 2016 Simon Noble Clinical Professor Palliative Medicine Cardiff University Wales, UK
Cancer associated thrombosis 17 th November 2016 Simon Noble Clinical Professor Palliative Medicine Cardiff University Wales, UK Today What is VTE? How does CAT differ? Initial anticoagulation Anticoagulation
More informationPerioperative VTE Prophylaxis
Perioperative VTE Prophylaxis Gregory J. Misky, M.D. Assistant Professor of Medicine University Of Colorado Denver You recommend the following 72 y.o. man admitted for an elective R hip repair. Patient
More informationDuration of Anticoagulant Therapy. Linda R. Kelly PharmD, PhC, CACP September 17, 2016
Duration of Anticoagulant Therapy Linda R. Kelly PharmD, PhC, CACP September 17, 2016 Conflicts of Interest No conflicts of interest to report Objectives At the end of the program participants will be
More informationSCIENTIFIC DISCUSSION
London, 25 January 2005 Product name: Arixtra Procedure No. EMEA/H/C/403/II/10 SCIENTIFIC DISCUSSION 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 74 18 86
More informationVTE Management in Oncology Patients
VTE Management in Oncology Patients October 24, 2014 Dr. Rufaro Chitsike MD MMed Haem, FCPath(Haem), Cert Clin(Haem) St. John s, Newfoundland Dr. Mary DeCarolis (Moderator) MD, GPO Housekeeping Sign the
More informationDrug Class Review Newer Oral Anticoagulant Drugs
Drug Class Review Newer Oral Anticoagulant Drugs Final Original Report May 2016 The purpose of reports is to make available information regarding the comparative clinical effectiveness and harms of different
More informationEAU GUIDELINES ON THROMBOPROPHYLAXIS IN UROLOGICAL SURGERY
EAU GUIDELINES ON THROMBOPROPHYLAXIS IN UROLOGICAL SURGERY K.A.O. Tikkinen (Chair), R. Cartwright, M.K. Gould, R. Naspro, G. Novara, P.M. Sandset, P.D. Violette, G.H. Guyatt Introduction Utilising recent
More informationCancer associated thrombosis
Cancer associated thrombosis Simon Noble Marie Curie Professor of Supportive and Palliative Medicine Marie Curie Palliative Care Research Centre Cardiff University Take home messages 1. Clots are cool
More informationVenous thromboembolism in cancer patients: an underestimated major health problem
Khalil et al. World Journal of Surgical Oncology (2015) 13:204 DOI 10.1186/s12957-015-0592-8 WORLD JOURNAL OF SURGICAL ONCOLOGY REVIEW Venous thromboembolism in cancer patients: an underestimated major
More informationSlide 1. Slide 2. Slide 3. Outline of This Presentation
Slide 1 Current Approaches to Venous Thromboembolism Prevention in Orthopedic Patients Hujefa Vora, MD Maria Fox, RN June 9, 2017 Slide 2 Slide 3 Outline of This Presentation Pathophysiology of venous
More informationGeneral. Recommendations. Guideline Title. Bibliographic Source(s) Guideline Status. Major Recommendations
General Guideline Title Prevention of deep vein thrombosis and pulmonary embolism. Bibliographic Source(s) American College of Obstetricians and Gynecologists (ACOG). Prevention of deep vein thrombosis
More informationObesity, renal failure, HIT: which anticoagulant to use?
Obesity, renal failure, HIT: which anticoagulant to use? Mark Crowther with thanks to Dr David Garcia and others. This Photo by Unknown Author is licensed under CC BY-SA 1 2 Drug choices The DOACs have
More informationEarly Ambulation Reduces the Risk of Venous Thromboembolism After Total Knee Replacement. Marilyn Szekendi, PhD, RN
Early Ambulation Reduces the Risk of Venous Thromboembolism After Total Knee Replacement Marilyn Szekendi, PhD, RN ANA 7 th Annual Nursing Quality Conference, February 2013 Research Team Banafsheh Sadeghi,
More informationROLE OF LOW MOLECULAR WEIGHT HEPARIN IN THE AGE OF DIRECT ORAL ANTICOAGULANTS
ROLE OF LOW MOLECULAR WEIGHT HEPARIN IN THE AGE OF DIRECT ORAL ANTICOAGULANTS Chee Yen Lin Consultant Haematologist NCIS Haematology National University Hospital Singapore Nomenclature direct oral anticoagulant
More informationShared Care Protocol for the Prescription and Supply of Low Molecular Weight Heparins
Tameside Hospital NHS Foundation Trust and NHS Tameside and Glossop Shared Care Protocol for the Prescription and Supply of Low Molecular Weight Heparins Version 5.2 Version: 5.2 Authorised by: Joint Medicines
More informationFrequently Asked Questions about Cancer Associated Thrombosis
+ Frequently Asked Questions about Cancer Associated Thrombosis Atlantic Canada Oncology Group Annual Meeting June 13 th, 2015 Sudeep Shivakumar, Dalhousie University + Conflict of Interest Disclosures
More informationCADTH Rapid Response Report: ASA for Venous Thromboembolism Prophylaxis: Evidence for Clinical Benefit and Harm
CADTH Rapid Response Report: ASA for Venous Thromboembolism Prophylaxis: Evidence for Clinical Benefit and Harm P. Timothy Pollak, MD, PhD University of Calgary Rocky Mountain/ACP Internal Medicine Meeting,
More informationSlide 1: Perioperative Management of Anticoagulation
Perioperative Management of Anticoagulation by Steven L. Cohn, MD, FACP Director, Medical Consultation Service, Kings County Hospital Center, Clinical Professor of Medicine, SUNY Downstate, Brooklyn, NY
More informationEuropean Journal of Internal Medicine
European Journal of Internal Medicine 2 (2013) 33 39 Contents lists available at SciVerse ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim Original article
More informationChallenges in Anticoagulation and Thromboembolism
Challenges in Anticoagulation and Thromboembolism Ethan Cumbler M.D. Assistant Professor of Medicine Hospitalist Medicine Section University of Colorado Denver May 2010 No Conflicts of Interest Objectives
More informationPreventing and Treating Venous Thromboembolism in Patients with Cancer
& ONCOLOGY BIO T ECH NEWS Priority Report Preventing and Treating Venous Thromboembolism in Patients with Cancer Alok A. Khorana, MD, FACP Associate Professor of Medicine and Oncology Vice Chief, Division
More informationTITLE: Acetylsalicylic Acid for Venous Thromboembolism Prophylaxis: A Review of Clinical Evidence, Benefits and Harms
TITLE: Acetylsalicylic Acid for Venous Thromboembolism Prophylaxis: A Review of Clinical Evidence, Benefits and Harms DATE: 23 August 2011 CONTEXT AND POLICY ISSUES: Thromboembolism occurs when a blood
More informationVenous Thromboembolism (VTE) Prevention
Venous Thromboembolism (VTE) Prevention 7 VTE Risk Assessment: General Patient Population Assess VTE risk at admission, post-op, and transfer See page 2 for VTE risk assessment among Obstetrical (OB) patients
More informationNew Oral Anticoagulants Prevention and Treatment of DVT and PE
New Oral Anticoagulants Prevention and Treatment of DVT and PE Grigoris T Gerotziafas Groupe de Thrombose Equipe de recherche ER2UPMC Interactions cellulaires tumorales et leur environnement et réponses
More informationComparison of Venothromboembolism Prophylaxis Practices in a Winnipeg Tertiary Care Hospital to Chest Guidelines: A Quality Improvement Project
Comparison of Venothromboembolism Prophylaxis Practices in a Winnipeg Tertiary Care Hospital to Chest Guidelines: A Quality Improvement Project Dr. Jonathan Laxton, FRCPC, R5 GIM University of Manitoba
More informationCancer-associated thrombosis: prevention and treatment
CANCER-ASSOCIATED THROMBOSIS MEDICAL ONCOLOGY Cancer-associated thrombosis: prevention and treatment K.M.J. Brose MD* and A.Y.Y. Lee MD MSc ABSTRACT Patients with cancer are at high risk to develop venous
More informationDraft. These draft recommendations are not final and therefore are not intended for use or citation.
ASH Recommendations for VTE in Non-Surgical Patients INTRODUCTION American Society of Hematology (ASH) guidelines are based on a systematic review of available evidence. Through a structured process, a
More informationAspirin as Venous Thromboprophylaxis
Canadian Society of Internal Medicine Nov 2, 2017 Aspirin as Venous Thromboprophylaxis Bill Geerts, MD, FRCPC Thromboembolism Consultant, Sunnybrook HSC Professor of Medicine, University of Toronto Disclosures
More informationPrevention of VTE in Nonsurgical Patients
CHEST Supplement ANTITHROMBOTIC THERAPY AND PREVENTION OF THROMBOSIS, 9TH ED: ACCP GUIDELINES Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based
More informationThromboprophylaxis in Hospitalized Medically Ill Cancer Patients. Candidate: Patricia Moretto
Thromboprophylaxis in Hospitalized Medically Ill Cancer Patients Candidate: Patricia Moretto Thesis for MSc in Epidemiology And Community Medicine Faculty of Medicine University of Ottawa Co-Supervisors:
More informationVTE PROPHYLAXIS IN ONCOLOGY OUTPATIENTS
SHARED CARE GUIDELINES VTE PROPHYLAXIS IN ONCOLOGY OUTPATIENTS Steering Committee Marc Carrier, MD, M.Sc., FRCP(C) Jay Easaw, MD, PhD, FRCP(C) Sudeep Shivakumar, MD, M.Sc., FRCP(C) Oncologists Scott Berry,
More informationPrevention of Venous Thromboembolism
Prevention of Venous Thromboembolism Surgical Care Improvement Project Dale W. Bratzler, DO, MPH President and CEO Dale W. Bratzler, DO, MPH Oklahoma Foundation for Medical Quality QIOSC Medical Director
More informationVTE Prevention After Hip or Knee Replacement
This Clinical Resource gives subscribers additional insight related to the Recommendations published in May 2018 ~ Resource #340506 VTE Prevention After Hip or Knee Replacement The American College of
More informationDEEP VEIN THROMBOSIS (DVT): TREATMENT
DEEP VEIN THROMBOSIS (DVT): TREATMENT OBJECTIVE: To provide an evidence-based approach to treatment of patients presenting with deep vein thrombosis (DVT). BACKGROUND: An estimated 45,000 patients in Canada
More informationDOACs in CAT. Fellow: Shweta Jain, MD Faculty Discussant: David Garcia, MD
DOACs in CAT Fellow: Shweta Jain, MD Faculty Discussant: David Garcia, MD Case 65 year old post menopausal female Left breast lesion Oct 2015 Biopsy Invasive ductal carcinoma Lumpectomy with SNB- pt1cno
More informationPrevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales
Prevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales Merimbula, 6 th November 2010 University of Sydney Department of Surgery Westmead Hospital
More informationVenous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community
Venous Thrombosis Venous Thrombosis It occurs mainly in the deep veins of the leg (deep vein thrombosis, DVT), from which parts of the clot frequently embolize to the lungs (pulmonary embolism, PE). Fewer
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) National Quality Strategy Domain: Patient Safety 2018 OPTIONS FOR INDIVIDUAL MEASURES:
More informationTRANSPARENCY COMMITTEE OPINION. 18 April 2007
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 18 April 2007 ARIXTRA 2.5 mg/0.5 ml, solution for injection in prefilled syringe Pack of 2 (CIP: 359 225-4) Pack of
More informationTHROMBOPROPHYLAXIS: NON-ORTHOPEDIC SURGERY
THROMBOPROPHYLAXIS: NON-ORTHOPEDIC SURGERY OBJECTIVE: To outline a practical approach for the prevention of venous thromboembolism (VTE) in patients undergoing non-orthopedic surgery. BACKGROUND: VTE is
More informationClinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden
Clinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden Clinical Policy Number: 05.01.03 Effective Date: January 1, 2016 Initial Review Date: July 15, 2015 Most Recent Review Date:
More informationAntithrombotic therapy in patients with transient ischemic attack / stroke (acute phase <48h)
Antithrombotic therapy in patients with transient ischemic attack / stroke (acute phase
More informationUpdates in Diagnosis & Management of VTE
Updates in Diagnosis & Management of VTE TRACY MINICHIELLO, MD CHIEF, ANTICOAGULATION& THROMBOSIS SERVICE-SAN FRANCISCO VAMC PROFESSOR OF MEDICINE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Financial Disclosures-NONE
More informationDENOMINATOR: All surgical patients aged 18 years and older undergoing procedures for which VTE prophylaxis is indicated in all patients
Measure #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) National Quality Strategy Domain: Patient Safety 2017 OPTIONS FOR INDIVIDUAL MEASURES:
More informationVenous Thromboembolism Prophylaxis
Approved by: Venous Thromboembolism Prophylaxis Vice President and Chief Medical Officer; and Vice President and Chief Operating Officer Corporate Policy & Procedures Manual Number: Date Approved January
More informationAnticoagulation for prevention of venous thromboembolism
Anticoagulation for prevention of venous thromboembolism Original article by: Michael Tam Note: updated in June 2009 with the eighth edition (from the seventh) evidence-based clinical practice guidelines
More informationWhat You Should Know
1 New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know The American Society
More informationMy Cancer Patient Has a Clot- Can I prescribe a Direct Oral Anticoagulant (DOAC)?
My Cancer Patient Has a Clot- Can I prescribe a Direct Oral Anticoagulant (DOAC)? November 24, 2018 Erica Peterson MD, FRCPC University of British Columbia Disclosures I participate in clinical research
More informationincidence of cancer-associated thrombosis (CAT) is further increased by additional risk factors such as chemotherapeutic 2
CANCER ASSOCIATED THROMBOSIS TREATMENT Patients with cancer are at a greater risk of developing venous thromboembolism than non-cancer patients, partly due to the ability of tumour cells to activate the
More informationUpdates in venous thromboembolism. Cecilia Becattini University of Perugia
Updates in venous thromboembolism Cecilia Becattini University of Perugia News for VTE Diagnosis Treatment the acute phase the agents Pulmonary embolism: diagnosis Vein ultrasonography Meta-analysis 15
More informationDisclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None
Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)
More information