title: Evidence-based guidance on venous thromboembolism in patients with solid tumours.
abstract: Venous thromboembolism (vte) is a serious, life-threatening complication of cancer. Anticoagulation therapy such as low molecular weight heparin (lmwh) has been shown to treat and prevent vte. Cancer therapy is often complex and ongoing, making the management of vte less straightforward in patients with cancer. There are no published Canadian guidelines available to suggest appropriate strategies for the management of vte in patients with solid tumours. We therefore aimed to develop a clear, evidence-based guideline on this topic. A systematic review of clinical trials and meta-analyses published between 2002 and 2013 in PubMed was conducted. Reference lists were hand-searched for additional publications. The National Guidelines Clearinghouse was searched for relevant guidelines. Recommendations were developed based on the best available evidence. In patients with solid tumours, lmwh is recommended for those with established vte and for those without established vte but with a high risk for developing vte. Options for lmwh include dalteparin, enoxaparin, and tinzaparin. No one agent can be recommended over another, but in the setting of renal insufficiency, tinzaparin is preferred. Unfractionated heparin can be used under select circumstances only (that is, when rapid clearance of the anticoagulant is desired). The most common adverse event is bleeding, but major events are rare, and with appropriate follow-up care, bleeding can be monitored and appropriately managed.
authors.affiliation: Guideline Utilization Resource Unit, Cancer-Control Alberta, Alberta Health Services, Calgary, AB.
authors.forename: M A
authors.initials: MA
authors.lastname: Shea-Budgell
authors.affiliation: Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
authors.forename: C M J
authors.initials: CM
authors.lastname: Wu
authors.affiliation: Division of Medical Oncology, Faculty of Medicine, University of Calgary Tom Baker Cancer Centre, Calgary, AB. ; Members of the Alberta Venous Thromboembolism Cancer Guideline Working Group: Jacob Easaw md p h d (chair), Peter Duggan md , Joshua Foley md , Anil Abraham Joy md , Lloyd A. Mack md ms c, Donald Morris md , Cindy Railton rn , Melissa A. Shea-Budgell ms c, Douglas Stewart md , A. Robert Turner md , Chris P. Venner md , and Janice Yurick pt .
authors.forename: J C
authors.initials: JC
authors.lastname: Easaw
keywords: Anticoagulation; clinical practice guidelines; deep-vein thrombosis; low molecular weight heparin; pulmonary embolism; solid tumours; systematic reviews; venous thromboembolism