FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence
Por:
Jimenez-Fonseca, P, Carmona-Bayonas, A, Calderon, C, Boj, JF, Font, C, Lecumberri, R, Monreal, M, Martin, AJM, Otero, R, Rubio, A, Ruiz-Artacho, P, Fernandez, CS, Colome, E and Segura, PP
Publicada:
1 ago 2017
Resumen:
Decision-making in cancer-related venous thromboembolism (VTE) is often founded on scant lines of evidence and weak recommendations. The aim of this work is to evaluate the percentage of agreement surrounding a series of statements about complex, clinically relevant, and highly uncertain aspects to formulate explicit action guidelines.
Opinions were based on a structured questionnaire with appropriate scores and were agreed upon using a Delphi method. Questions were selected based on a list of recommendations with low evidence from the Spanish Society of Oncology Clinical Guideline for Thrombosis. The questionnaire was completed in two iterations by a multidisciplinary panel of experts in thrombosis.
Of the 123 statements analyzed, the panel concurred on 22 (17%) and another 81 (65%) were agreed on by qualified majority, including important aspects of long-term and prolonged anticoagulation, major bleeding and rethrombosis management, treatment in special situations, catheter-related thrombosis and thromboprophylaxis. Among them, the panelists agreed the incidental events should be equated to symptomatic ones, long-term and extended use of full-dose low-molecular weight heparin, and concluded that the Khorana score is not sensitive enough to uphold an effective thromboprophylaxis strategy.
Though the level of consensus varied depending on the scenario presented, overall, the iterative process achieved broad agreement as to the general treatment principles of cancer-associated VTE. Clinical validation of these statements in genuine practice conditions would be useful.
Filiaciones:
Jimenez-Fonseca, P:
Hosp Univ Cent de Asturias, Dept Med Oncol, Oviedo, Spain
Carmona-Bayonas, A:
Hosp Univ Morales Meseguer, Hematol & Med Oncol Dept, UMU, IMIB, Murcia, Spain
Calderon, C:
Univ Barcelona, Fac Psychol, Clin Psychol & Psychobiol Dept, Barcelona, Spain
Boj, JF:
Hosp Univ Santa Creu & St Pau, Unitat Hemostasia & Trombosi, Barcelona, Spain
Font, C:
Hosp Univ Clin, Dept Med Oncol, IDIBAPS Translat Genom & Targeted Therapeut Solid, Barcelona, Spain
Lecumberri, R:
Clin Univ Navarra, Hemaotol Dept, Pamplona, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Badalona, Spain
Martin, AJM:
Hosp Univ Gregorio Maranon, Dept Med Oncol, Madrid, Spain
Otero, R:
Univ Seville, Inst Biomed Sevilla IBiS, Hosp Univ Virgen del Rocio, Med Surg Unit Resp Dis,CSIC,CIBERES, Seville, Spain
Rubio, A:
Hosp Virgen de la Salud, Dept Pharm, Toledo, Spain
Ruiz-Artacho, P:
Hosp Univ Clin San Carlos, Emergency Dept, IdISSC, Madrid, Spain
Fernandez, CS:
Hosp Univ La Princesa, Dept Internal Med, Madrid, Spain
Colome, E:
LEO Pharma, Sci Affairs, Barcelona, SA, Spain
Segura, PP:
Hosp Univ Clin San Carlos, Dept Med Oncol, Madrid, Spain
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