title: Clinical challenges in patients with cancer-associated thrombosis: Canadian expert consensus recommendations.
abstract: Venous thromboembolism is a common complication in cancer patients, and thromboembolism is the second most common cause of death after cancer progression. A number of clinical practice guidelines provide recommendations for the management of cancer-associated thrombosis. However, the guidelines lack recommendations covering commonly encountered clinical challenges (for example, thrombocytopenia, recurrent venous thromboembolism, etc.) for which little or no evidence exists. Accordingly, recommendations were developed to provide expert guidance to medical oncologists and other health care professionals caring for patients with cancer-associated thrombosis. The current expert consensus was developed by a team of 21 clinical experts. For each identified clinical challenge, the literature in medline, embase, and Evidence Based Medicine Reviews was systematically reviewed. The quality of the evidence was assessed, summarized, and graded. Consensus statements were generated, and the experts voted anonymously using a modified Delphi process on their level of agreement with the various statements. Statements were progressively revised through separate voting iterations and were then finalized. Clinicians using these recommendations and suggestions should tailor patient management according to the risks and benefits of the treatment options, patient values and preferences, and local cost and resource allocations.
authors: Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON.
authors: M
authors: M
authors: Carrier
authors: Departments of Medicine, Oncology, and Epidemiology and Biostatistics, University of Western Ontario, London, ON.
authors: A
authors: A
authors: Lazo-Langner
authors: Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS.
authors: S
authors: S
authors: Shivakumar
authors: Department of Medicine, Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC.
authors: V
authors: V
authors: Tagalakis
authors: Thrombosis and Atherosclerosis Research Institute, Department of Medicine, McMaster University, Hamilton, ON.
authors: P L
authors: PL
authors: Gross
authors: Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC.
authors: N
authors: N
authors: Blais
authors: Department of Oncology, University of Alberta, Edmonton, AB.
authors: C A
authors: CA
authors: Butts
authors: St. Joseph's Hospital, and Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON.
authors: M
authors: M
authors: Crowther
keywords: Venous thromboembolism; deep-vein thrombosis; pulmonary embolism; recommendations