title: Prevention of venous thromboembolism in patients with cancer: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET)(1).
abstract: BACKGROUND
  Prevention of venous thromboembolism (VTE) in cancer patients remains controversial in most clinical settings.
  
  
  OBJECTIVE
  The Italian Society for Haemostasis and Thrombosis (SISET) commissioned a project to develop clinical practice guidelines for the prevention of VTE in patients with malignancy.
  
  
  METHODS
  Key questions concerning the prevention of VTE in patients with malignancy were formulated by a multidisciplinary working group consisting of experts in clinical medicine and research. After a systematic review and discussion of the literature, recommendations were formulated and graded according to the supporting evidence. For those questions for which the literature search did not find any definitive answers (due to absence of evidence, low quality evidence and/or contradictory evidence), a formal consensus method was used instead to issue clinical recommendations.
  
  
  RESULTS
  The search for "VTE prevention" resulted in 1021 citations; 69 articles were selected and 24 were used for drafting clinical recommendations. Four areas were graded A to C: 1) Need of prevention (pharmacological and/or mechanical) in cancer patients undergoing major abdominal or pelvic surgery and in 2) those with an acute medical disease requiring hospitalization and who are bedridden. Avoid prevention in 3) cancer patients with a central venous catheter and 4) those on chemotherapy, radiotherapy or hormonal therapy, except patients with multiple myeloma treated with thalidomide/lenalidomide plus high-dose dexamethasone, and those with gastrointestinal or lung cancer. Six areas were considered to be clinically important, but lacked evidence from the literature and thus required a formal consensus (grade D): 1) need of prevention during chemo- radiotherapy or hormonal therapy in patients with previous VTE; 2) optimal duration of pharmacological prevention in patients who are hospitalized/bedridden for acute medical illness; 3) optimal duration of pharmacological prevention in patients undergoing major surgery other than abdominal and pelvic; 4) optimal duration of pharmacological prevention in myeloma patients receiving thalidomide plus dexamethasone; 5) presence of cerebral metastasis as a contraindication to pharmacological prevention; 6) prevention in cancer patients undergoing surgery by laparoscopic procedures lasting>30min.
  
  
  CONCLUSIONS
  Results of the systematic literature review and an explicit approach to consensus techniques have led to recommendations for the most clinically important issues in the prevention of VTE in cancer patients.
authors.affiliation: Cattedra ed UO di Ematologia con trapianto, Dipartimento di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico di Palermo, Via del Vespro 127, 90127 Palermo, Italy. sergio.siragusa@unipa.it
authors.forename: Sergio
authors.initials: S
authors.lastname: Siragusa
authors.forename: Ugo
authors.initials: U
authors.lastname: Armani
authors.forename: Monica
authors.initials: M
authors.lastname: Carpenedo
authors.forename: Anna
authors.initials: A
authors.lastname: Falanga
authors.forename: Fabio
authors.initials: F
authors.lastname: Fulfaro
authors.forename: Davide
authors.initials: D
authors.lastname: Imberti
authors.forename: Renzo
authors.initials: R
authors.lastname: Laurora
authors.forename: Angelo Claudio
authors.initials: AC
authors.lastname: Molinari
authors.forename: Domenico
authors.initials: D
authors.lastname: Prisco
authors.forename: Mauro
authors.initials: M
authors.lastname: Silingardi
authors.forename: Melina
authors.initials: M
authors.lastname: Verso
authors.forename: Adriana
authors.initials: A
authors.lastname: Visonà
mesh_terms: D006487:Hemostasis; D006801:Humans; D007558:Italy; D009369:Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000473:pathology* / Q000517:prevention & control* / Q000628:therapy