Summary
Low-molecular-weight heparin (LWMH) is recommended as the preferred anticoagulant
treatment over vitamin K antagonists (VKA) for venous thromboembolism (VTE) in patients
with cancer. However, there is uncertainty about the duration and dose of LMWH treatment.
Therefore, we designed this multinational survey to assess the current approach to
the treatment of patients with cancer and VTE. An electronic survey tool was used
to disseminate a survey containing 49 questions on different aspects of the treatment
of patients with cancer and VTE, among both thrombosis and non-thrombosis specialists.
A total of 229 invitations were sent, and 141 completed the survey (60% of the total).
Fifty-eight percent of the respondents were from Europe, 35% from the US and the remaining
7% from other countries. Respondent’s specialties included haematology (23%), oncology
(18%), pulmonology (15%) and general internal medicine (15%). LMWH was indicated as
the first choice for the long-term treatment by 82% of the respondents, of whom 60%
used full therapeutic doses and 40% chose a dose reduction. When continuing anticoagulants
after the long-term treatment period, 44% of respondents preferred LMWH, 10% VKA,
while the remaining 45% chose per individual patient for either LMWH or VKA. In conclusion,
we observed a relatively high observance rate of the guidelines with respect to the
use of LMWH for the long-term treatment of VTE in cancer. In contrast, the dose of
LMWH and the type of anticoagulant chosen after the initial 3–12 months varied substantially,
probably reflecting the limited available evidence.
Keywords
Anticoagulant treatment - venous thrombosis - malignancy
