A worldwide survey to assess the current approach to the treatment of patients with cancer and venous thromboembolism

Introduction: Since the results of the CLOT trial were published in 2003, low-molecular-weight heparin (LWMH) has been recommended as the preferred anticoagulant treatment over vitamin K antagonists (VKAs) for venous thromboembolism (VTE) in patients with cancer. However, there is uncertainty about the duration and dose of LMWH treatment. We assessed the current practice of anticoagulant treatment of patients with cancer and VTE in various countries. Methods: An electronic survey tool was used to build a survey containing 49 questions on different aspects of the treatment of patients with cancer and VTE, and personal links were sent to both thrombosis and non-thrombosis specialists. Results: For this analysis, 123 completed surveys were available, which represented 53% of all invitations to date. Respondent's specialties varied from haematology (26%), oncology (17%), haemato-oncology (4.1%), pulmonology (14%), general internal medicine (13%), surgery (4.9%) and other (1.6%). The majority (85%) of respondents generally use LMWH for longterm anticoagulant treatment. The application of LMWH is significantly higher (p=0.031) among European respondents (69/75; 92%) compared to respondents from the United States or Canada (30/40, 75%). Of all specialists who give LMWH for long-term treatment, 55% use fully therapeutic doses, while the remainder chooses for a dose reduction after a certain period of time. When continuing anticoagulants after the long-term treatment period, 45% of respondents prefer LMWH, 9.0% VKA, while the others choose per individual patient for either LMWH or VKA. In patients on LMWH who develop recurrent VTE during treatment, 42% of the respondents continue LWMH with a higher dose, 8.2% give double therapy with LMWH and VKA and 30% would insert a vena caval filter. Discussion: In this pre-final assessment, we observed a relatively high observance rate of the guidelines, with respect to the type of anticoagulant used for the long-term treatment of VTE in cancer patients. In contrast, the dose of LMWH and the continuation of treatment after 6 months are examples of areas in which heterogeneous responses may reflect the limited available clinical evidence. Interestingly, a lower percentage of the specialists in the US routinely use LMWH in patients with cancer compared to European specialists

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