Treatment of venous thromboembolism in patients with cancer: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET)
Davide Imberti a, Marcello Di Nisio c, Maria Benedetta Donati d, Anna Falanga e, Angelo Ghirarduzzi f, Daniele Guarneri g, Franco Piovella h, Rita Carlotta Santoro i, Edoardo Baldini b,
Stefania Zampogna j
a) Specialist in Internal Medicine, Director of the Thrombosis Centre, Emergency Department, Piacenza Hospital, Italy
b) Consultant Surgeon, Medical Doctor, Vascular and General Surgery, Piacenza Hospital, Italy
c) Specialist in Internal Medicine, Medical Pathology Unit, “SS.ma Annunziata” Hospital, Chieti, Italy
d) Consultant Clinical and Laboratory Haematologist, Researcher in the field of the relationships between tumours and thrombosis, Coordinator of Research Laboratory Scientific Projects, Cattolica University, Campobasso, Italy
e) Consultant Haematologist, Medical Manager, Haematology Division, Director of Specialist Haemostasis Laboratory, Bergamo, Italy
f) Consultant in Internal Medicine and Cardiology, Angiology Unit, Department of Internal Medicine, Santa Maria Nuova Hospital, Reggio Emilia, Italy
g) Medical Doctor, Accident and Emergency Medicine Department, Fidenza Hospital (Parma), Italy
h) Consultant in Haematology and Internal Medicine, Director of Angiology 1- Thromboembolic Disorders Unit, San Matteo Hospital, Pavia, Italy
i) Consultant in Medical Oncology – Clinical and Laboratory Haematology, Director, Haemophilia Centre – Haemostasis and Thrombosis Service, Oncohaematology Department, “Pugliese-Ciaccio” Hospital, Catanzaro, Italy
j) Consultant Paediatrician, Paediatrics Unit, “Pugliese-Ciaccio” Hospital, Catanzaro, Italy
Abstract
Background
The treatment of venous thromboembolism (VTE) in cancer patients remains controversial.
Purpose
The Italian Society for Thrombosis and Haemostasis (SISET) commissioned a project to develop clinical practice guidelines for the therapy of VTE in patients with malignancies.
Methods
Key questions about the treatment of VTE in patients with malignancies were formulated by a multidisciplinary working group consisting of experts in clinical medicine and research. After a systematic review and discussion of the literature, recommendations were formulated and graded according to the supporting evidence. For those questions for which the literature search did not yield any definitive answer (absence of evidence evidence of low quality, and contradictory evidence), a formal consensus method was used to issue clinical recommendations.
Results
The results of the available literature on VTE treatment in cancer patients were reviewed and clinical recommendations were drafted.
Conclusion
We describe the results of a systematic literature review and an explicit approach to consensus techniques which resulted in recommendations for the key therapeutic issues in cancer patients with VTE.