Treating and Preventing Cancer-Associated VTE: Combining Updated Recommendations and Real-World Data

Patients with cancer are at increased risk for thrombotic complications, ranging from abnormal coagulation tests in the absence of clinical manifestations to deep vein thrombosis, pulmonary embolism, and fatal thromboembolism. Despite the relatively high incidence of such events, many patients with cancer are not receiving adequate anticoagulant prophylaxis and treatment.

In this educational series, a distinguished panel of faculty experts provides an in-depth review of optimal management strategies for cancer-associated venous thromboembolism (VTE), including a detailed discussion of new data on the efficacy and safety of novel oral anticoagulants. Updated evidence-based guidelines for both prevention and treatment of VTE will be discussed, as will the latest real-world data and guidance on how best to incorporate this guidance into routine practice.

Intended Audience

Hematologists-oncologists, physicians, nurse practitioners (NPs), physician assistants (PAs), internal medicine clinicians, hospitalists, emergency department physicians, oncology nurses, and specialty pharmacists

Educational Objectives

At the conclusion of this activity, participants should be better able to:

  • Describe the indications and contraindications for choosing treatment for acute venous thromboembolism (VTE) in patients with cancer, based on recent guidelines and clinical trials
  • Assess risks for VTE and bleeding in patients with cancer
  • Counsel patients with cancer about the rationale for an anticoagulation regimen and provide information on the risks and benefits of such regimens to foster therapeutic adherence
  • Describe the key concepts in the prevention and treatment of VTE in patients with cancer, including the need to stratify patients according to their individual level of risk
  • Apply updated evidence-based guideline recommendations for the prevention and treatment of cancer-related VTE in routine clinical practice
  • Employ individualized anticoagulation regimens for prevention and treatment of VTE in patients with cancer, based on the unique needs and characteristics of each patient

Preventing and Treating Cancer-Associated VTE: Pearls for Practice

Release: June 14, 2019
Expiration: June 14, 2020

CME|CPE|CE 0.50 Credit

Case Study: Suspected VTE Following Radical Prostatectomy

Release: June 28, 2019
Expiration: June 28, 2020

CME|CPE|CE 1.00 Credit

Resources

For Patients

Preventing and Treating Blood-Clot Disorders: What All Patients With Cancer Need to Know

For Clinicians

Agency for Healthcare Research and Quality (AHQR). Preventing avoidable readmissions: improving the hospital discharge process. AHRQ website. https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/impptdis/index.html. Updated February 2017.

Agnelli G, Becattini C, Bauersachs R, et al; Caravaggio Study Investigators. Apixaban versus dalteparin for the treatment of acute venous thromboembolism in patients with cancer: the Caravaggio study. Thromb Haemost. 2018;118(9):1668-1678. doi:10.1055/s-0038-1668523.

Carrier M, Lazo-Langner A, Shivakumar S, et al. Clinical challenges in patients with cancer-associated thrombosis: Canadian expert consensus recommendations. Curr Oncol. 2015;22(1):49-59. doi:10.3747/co.22.2392.

Cosma E, Prunty JJ. Direct oral anticoagulants in cancer patients. US Pharm. 2018;43(8 suppl):2-11. https://www.uspharmacist.com/article/direct-oral-anticoagulants-in-cancer-patients.

Expert Steering Group. Cancer-associated thrombosis (CAT), a neglected cause of cancer death: actions needed to increase health outcomes and reduce mortality. A report summarising the findings of an Expert Steering Group meeting in Belgium; December 11-12, 2015; Brussels, Belgium. https://www.anticoagulationuk.org/downloads/European%20CAT%20White%20Paper.pdf.

Farge D, Bounameaux H, Brenner B, et al. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2016;17(10):e452-e466. doi:10.1016/S1470-2045(16)30369-2.

Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-352. doi:10.1016/j.chest.2015.

Khorana AA, Nobel S, Lee AYY, et al. Role of direct oral anticoagulants in the treatment of cancer‐associated venous thromboembolism: guidance from the SSC of the ISTH. J Thromb Haemost. 2018;16(9):1891-1894. doi:10.1111/jth.14219.

Khorana risk score for venous thromboembolism in cancer patients. MDCalc website. https://www.mdcalc.com/khorana-risk-score-venous-thromboembolism-cancer-patients. [The Khorana risk score (calculator) was first published in 2008.]

Lyman GH, Bohlke K, Falanga A. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Oncol Pract. 2015;11(3):e442-e444. doi:10.1200/JOP.2015.004473.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Cancer-associated venous thromboembolic disease. Version 1.2019. https://www.nccn.org/professionals/physician_gls/pdf/vte.pdf. Published February 28, 2019.

National Institute for Health and Care Excellence (NICE). Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism [NICE guideline (NG89)]. https://www.nice.org.uk/guidance/ng89. Published March 2018.

FACULTY

Kenneth A. Bauer, MD
Professor of Medicine
Harvard Medical School
Member, Hematology-Oncology Division
Beth Israel Deaconess Medical Center
Boston, MA

Benjamin Djulbegovic, MD, PhD
Professor
Hematology & Hematopoietic Cell
  Transplantation and Population Sciences
Director, Program for Evidence-based
  Medicine & Comparative Effectiveness
  Research
Department of Supportive Medicine
Director of Research, Department
  of Hematology
City of Hope Cancer Research Hospital
Duarte, CA

Alok A. Khorana, MD, FACP, FASCO
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Director, Gastrointestinal Malignancies
  Program
Cleveland Clinic
Cleveland, OH

Jointly provided by

and

These activities are supported by an educational grant from
the Bristol-Myers Squibb and Pfizer Alliance.