Pulmonary embolism special scenario cancer: Difference between revisions
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==Overview== | ==Overview== | ||
[[Cancer]] patients who have an episode of pulmonary embolism should receive an extended [[anticoagulation therapy]] for at least 3 months. The first line long term anticoagulation therapy for [[venous thromboembolism]] in [[cancer]] patients is [[vitamin K antagonist]] ([[VKA]]) over [[low molecular weight heparin]] ([[LMWH]]). | [[Cancer]] patients who have an episode of pulmonary embolism should receive an extended [[anticoagulation therapy]] for at least 3 months. The first line long term anticoagulation therapy for [[venous thromboembolism]] (VTE) in [[cancer]] patients is [[vitamin K antagonist]] ([[VKA]]) over [[low molecular weight heparin]] ([[LMWH]]). Outpatient [[cancer]] patients with no additional risk factors for [[VTE]] should not receive any routine VTE prophylaxis. | ||
==2012 Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (DO NOT EDIT)<ref name="pmid22315257">{{cite journal| author=Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ, American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel| title=Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= 7S-47S | pmid=22315257 | doi=10.1378/chest.1412S3 | pmc=PMC3278060 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315257 }} </ref>== | ==2012 Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (DO NOT EDIT)<ref name="pmid22315257">{{cite journal| author=Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ, American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel| title=Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= 7S-47S | pmid=22315257 | doi=10.1378/chest.1412S3 | pmc=PMC3278060 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315257 }} </ref>== | ||
Revision as of 20:58, 13 July 2014
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Resident Survival Guide |
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Pulmonary Embolism Microchapters |
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Diagnosis |
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Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores |
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Treatment |
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Follow-Up |
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Special Scenario |
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Trials |
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Case Studies |
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Pulmonary embolism special scenario cancer On the Web |
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Directions to Hospitals Treating Pulmonary embolism special scenario cancer |
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Risk calculators and risk factors for Pulmonary embolism special scenario cancer |
Editor(s)-In-Chief: C. Michael Gibson, M.S., M.D. [1], The APEX Trial Investigators; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Cancer patients who have an episode of pulmonary embolism should receive an extended anticoagulation therapy for at least 3 months. The first line long term anticoagulation therapy for venous thromboembolism (VTE) in cancer patients is vitamin K antagonist (VKA) over low molecular weight heparin (LMWH). Outpatient cancer patients with no additional risk factors for VTE should not receive any routine VTE prophylaxis.
2012 Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (DO NOT EDIT)[1]
Long-term Treatment of Patients With PE (DO NOT EDIT)[1]
| Class I |
| "1. In patients with PE who are treated with VKA, we recommend a therapeutic INR range of 2.0 to 3.0 (target INR of 2.5) over a lower (INR < 2) or higher (INR 3.0-5.0) range for all treatment durations. (Level of Evidence: B)" |
| "2. In patients with PE and active cancer, if there is a low or moderate bleeding risk, we recommend extended anticoagulant therapy over 3 months of therapy. (Level of Evidence: B)" |
| Class II |
| "1. In patients with PE and active cancer, if there is a high bleeding risk, we suggest extended anticoagulant therapy. (Level of Evidence: B)" |
| "2. In patients with PE and no cancer, we suggest VKA therapy over LMWH for long-term therapy (Level of Evidence: C). For patients with PE and no cancer who are not treated with VKA therapy, we suggest LMWH over dabigatran or rivaroxaban for long-term therapy. (Level of Evidence: C)" |
| "3. In patients with PE and cancer, we suggest LMWH over VKA therapy (Level of Evidence: B). In patients with PE and cancer who are not treated with LMWH, we suggest VKA over dabigatran or rivaroxaban for long-term therapy (Level of Evidence: C). " |
Patients Undergoing General, GI, Urological, Gynecologic, Bariatric, Vascular, Plastic, or Reconstructive Surgery (DO NOT EDIT)[1]
| Class I |
| "1. For high-VTE-risk patients undergoing abdominal or pelvic surgery for cancer who are not otherwise at high risk for major bleeding complications, we recommend extended-duration pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis. (Level of Evidence: B)" |
Patients With Cancer in the Outpatient Setting (DO NOT EDIT)[1]
| Class I |
| "1. In outpatients with cancer who have no additional risk factors for VTE, we recommend against the prophylactic use of VKAs. (Level of Evidence: B)" |
| Class II |
| "1. In outpatients with cancer who have no additional risk factors for VTE, we suggest against routine prophylaxis with LMWH or LDUH. (Level of Evidence: B)" |
| "2. In outpatients with solid tumors who have additional risk factors for VTE and who are at low risk of bleeding, we suggest prophylactic-dose LMWH or LDUH over no prophylaxis. (Level of Evidence: B)" |
| "3. In outpatients with cancer and indwelling central venous catheters, we suggest against routine prophylaxis with LMWH or LDUH (Level of Evidence: B) and suggest against the prophylactic use of VKAs (Level of Evidence: C). " |
References
- ↑ 1.0 1.1 1.2 1.3 Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ, American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel (2012). "Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): 7S–47S. doi:10.1378/chest.1412S3. PMC 3278060. PMID 22315257.