title: [Adherence to guidelines for the treatment of venous thromboembolism in cancer patients: a retrospective analysis of 145 cases].
abstract: OBJECTIVE
  To assess adherence to French guidelines for curative treatment of thromboembolism in cancer patients, and to identify factors limiting their implementation.
  
  
  METHODS
  Retrospective analysis of the medical files of cancer patients diagnosed with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in one site between January 1st, 2010 and June 30th, 2011. Central venous catheter thrombosis and superficial vein thrombosis were excluded.
  
  
  RESULTS
  The series included 145 patients, among whom 113 (78%) had solid tumors (at a metastatic stage in 68% of cases) and 33 (22%) had hematologic malignancies. Low molecular weight heparin (LMWH) was prescribed as long-term treatment (>10 days) for 83 patients (57.2%) and a vitamin K antagonist (VKA) for 33 patients (22.7%). Bleeding required treatment modifications or discontinuation in 11 (7.5%) and 10 (6.8%) patients respectively. After 6 months, LMWH, VKA and fondaparinux were prescribed for 28, 27 and six (19.3%, 18.6% et 4.1%) patients respectively. Mean duration of anticoagulation was 176.8 days. Treatment was not affected by a history of venous thromboembolism, the presence of pulmonary embolism or proximal deep vein thrombosis but it was significantly shorter in case of thrombosis limited to muscular veins (115.5 vs 182.3 days, P<0.05). Overall, guidelines were fully implemented in only 68 (46.9%) patients, with regards to the choice of pharmacological class and duration of treatment.
  
  
  CONCLUSIONS
  Adherence to national guidelines is insufficient and actions must be taken to improve the management of venous thromboembolism in cancer patients.
authors.affiliation: Service de Médecine Interne, CHU de Poitiers, 2 rue de la Milétrie, BP 577, 86021 Poitiers cedex, France. rafik.belhadj-chaidi@chu-poitiers.fr
authors.forename: R
authors.initials: R
authors.lastname: Belhadj Chaidi
authors.forename: C
authors.initials: C
authors.lastname: Thollot
authors.forename: A
authors.initials: A
authors.lastname: Ferru
authors.forename: P
authors.initials: P
authors.lastname: Roblot
authors.forename: C
authors.initials: C
authors.lastname: Landron
mesh_terms: D015110:4-Hydroxycoumarins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004363:Drug Utilization; D005260:Female; D000077425:Fondaparinux; D005602:France; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000628:therapy; D011134:Polysaccharides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D019851:Thrombophilia / Q000188:drug therapy / Q000209:etiology; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000188:drug therapy; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D015110:4-Hydroxycoumarins; D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D000077425:Fondaparinux