title: Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 1: prophylaxis.
abstract: Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy has been shown to prevent vte; however, unique clinical circumstances in patients with cancer can often complicate the decisions surrounding the administration of prophylactic anticoagulation. No national Canadian guidelines on the prevention of cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic. PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations. Low molecular weight heparin can be used prophylactically in cancer patients at high risk of developing vte. Direct oral anticoagulants are not recommended for vte prophylaxis at this time. Specific clinical scenarios, including renal insufficiency, thrombocytopenia, liver disease, and obesity can warrant modifications in the administration of prophylactic anticoagulant therapy. There is no evidence to support the monitoring of anti-factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, factor Xa levels could be checked at baseline and periodically in patients with renal insufficiency. The use of anticoagulation therapy to prolong survival in cancer patients without the presence of risk factors for vte is not recommended.
authors.affiliation: Alberta: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea- Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea-Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek).
authors.forename: J C
authors.initials: JC
authors.lastname: Easaw
authors.affiliation: Alberta: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea- Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea-Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek).
authors.forename: M A
authors.initials: MA
authors.lastname: Shea-Budgell
authors.affiliation: Alberta: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea- Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea-Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek).
authors.forename: C M J
authors.initials: CM
authors.lastname: Wu
authors.affiliation: Manitoba: Department of Medicine, University of Manitoba, Cancer Care Manitoba, Winnipeg (Czaykowski).
authors.forename: P M
authors.initials: PM
authors.lastname: Czaykowski
authors.affiliation: Quebec: Hôpital Maisonneuve-Rosemont, Montreal (Kassis); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal (Tagalakis); Department of Oncology, Faculty of Medicine, McGill University, Montreal (Kavan).
authors.forename: J
authors.initials: J
authors.lastname: Kassis
authors.affiliation: Ontario: Scientific Insights Consulting Group, Mississauga (Kuehl); Department of Medicine, St. Michael's Hospital Division of Nephrology, University of Toronto, Toronto (McFarlane); Department of Oncology, Western University, London (Welch).
authors.forename: B
authors.initials: B
authors.lastname: Kuehl
authors.affiliation: British Columbia: Department of Medical Oncology, BC Cancer Agency, Vancouver (Lim); BC Provincial Renal Agency and Faculty of Pharmaceutical Sciences, University of British Columbia and Royal Jubilee Hospital, Victoria (Martinusen).
authors.forename: H J
authors.initials: HJ
authors.lastname: Lim
authors.affiliation: Nova Scotia: Department of Medicine, Dalhousie University, Halifax (MacNeil); Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax (Shivakumar).
authors.forename: M
authors.initials: M
authors.lastname: MacNeil
authors.affiliation: British Columbia: Department of Medical Oncology, BC Cancer Agency, Vancouver (Lim); BC Provincial Renal Agency and Faculty of Pharmaceutical Sciences, University of British Columbia and Royal Jubilee Hospital, Victoria (Martinusen).
authors.forename: D
authors.initials: D
authors.lastname: Martinusen
authors.affiliation: Ontario: Scientific Insights Consulting Group, Mississauga (Kuehl); Department of Medicine, St. Michael's Hospital Division of Nephrology, University of Toronto, Toronto (McFarlane); Department of Oncology, Western University, London (Welch).
authors.forename: P A
authors.initials: PA
authors.lastname: McFarlane
authors.affiliation: Alberta: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea- Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea-Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek).
authors.forename: E
authors.initials: E
authors.lastname: Meek
authors.affiliation: Saskatchewan: Department of Medicine, Division of Hematology, University of Saskatchewan, Saskatoon (Moodley).
authors.forename: O
authors.initials: O
authors.lastname: Moodley
authors.affiliation: Nova Scotia: Department of Medicine, Dalhousie University, Halifax (MacNeil); Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax (Shivakumar).
authors.forename: S
authors.initials: S
authors.lastname: Shivakumar
authors.affiliation: Quebec: Hôpital Maisonneuve-Rosemont, Montreal (Kassis); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal (Tagalakis); Department of Oncology, Faculty of Medicine, McGill University, Montreal (Kavan).
authors.forename: V
authors.initials: V
authors.lastname: Tagalakis
authors.affiliation: Ontario: Scientific Insights Consulting Group, Mississauga (Kuehl); Department of Medicine, St. Michael's Hospital Division of Nephrology, University of Toronto, Toronto (McFarlane); Department of Oncology, Western University, London (Welch).
authors.forename: S
authors.initials: S
authors.lastname: Welch
authors.affiliation: Quebec: Hôpital Maisonneuve-Rosemont, Montreal (Kassis); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal (Tagalakis); Department of Oncology, Faculty of Medicine, McGill University, Montreal (Kavan).
authors.forename: P
authors.initials: P
authors.lastname: Kavan
keywords: Low molecular weight heparin; anticoagulation; clots; deep vein thrombosis; practice guideline; prophylaxis; pulmonary embolism; venous thromboembolism