ASH: First Int'l Good Clinical Practice Guidelines for Use of Antithrombotics

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ATLANTA—Noting the second cause of death in patients with cancer is venous thromboembolism (VTE), global experts called on colleagues attending the 54th American Society of Hematology Annual Meeting and Exposition to help disseminate and implement the first International Good Clinical Practice Guidelines for the use of antithrombotics.

Developed by a working group of 24 global experts and evaluated by 45 independent experts and three patient representatives, the Good Clinical Practice Guidelines are designed to address the worldwide heterogeneity in managing patients with VTE, a “major public health priority,” noted Dominique Farge, MD, of the French Cancer Institute, Paris, which provided methodological support.

The working group reviewed all MEDLINE studies on cancer, VTE, pulmonary embolism, and anticoagulant drugs published from 1996 to 2011 in which primary study outcomes were VTE rates, major and minor bleeding, thrombocytopenia, and death.

Data from these studies were entered in evidence tables and validated. “High A, Moderate B, Low C, Very low D levels of evidence depended on study design, limitations, inconsistency, indirectness, imprecision and publication bias,” Dr. Farge reported.

Guidelines were classified as strong (Grade 1) or weak (Grade 2) based on GRADE appraisal grids. In the absence of scientific evidence, a consensus of the Working Group was defined as Best Clinical Practice.

Highlights of the guidelines, which focus on four specific areas for the use of antithrombotics in patients with cancer, include:

  • For initial treatment of VTE, low molecular weight heparin (LMWH) is recommended.
  • To prevent postoperative VTE, LMWH once a day or low-dose unfractionated heparin three times a day are recommended; anticoagulant drug prophylaxis should start 12 to 2 hours preoperatively and continued at least 7 to 10 days.
  • In hospitalized patients with reduced mobility, prophylaxis with LMWH unfractionated heparin or fondaparinux is recommended.
  • A brain tumor per se is not a contraindication to anticoagulant drug for established VTE, for which LMWH is preferred. LMWH or unfractionated heparin is recommended postoperatively to prevent VTE in neurosurgery cancer patients.

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