ABSTRACT
Venous thromboembolism (VTE) is common in patients with cancer and increases morbidity and mortality. VTE prevention and treatment are more complex in patients with cancer. The NCCN Guidelines for Cancer-Associated Venous Thromboembolic Disease outline strategies for treatment and prevention of VTE in adult patients diagnosed with cancer or in whom cancer is clinically suspected. These NCCN Guidelines Insights explain recent changes in anticoagulants recommended for the treatment of cancer-associated VTE.
Subject(s)
Anticoagulants/administration & dosage , Hemorrhage/prevention & control , Medical Oncology/standards , Neoplasms/complications , Venous Thromboembolism/drug therapy , Anticoagulants/adverse effects , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Therapy, Combination/methods , Drug Therapy, Combination/standards , Hemorrhage/chemically induced , Hemorrhage/mortality , Humans , Medical Oncology/methods , Medication Adherence , Neoplasms/mortality , Patient Selection , Randomized Controlled Trials as Topic , Societies, Medical/standards , Survival Analysis , Time Factors , Treatment Outcome , United States , Venous Thromboembolism/diagnosis , Venous Thromboembolism/etiology , Venous Thromboembolism/mortalityABSTRACT
The NCCN Guidelines for Cancer-Associated Venous Thromboembolic Disease outline strategies for treatment and prevention of venous thromboembolism (VTE) in adult patients with a diagnosis of cancer or for whom cancer is clinically suspected. VTE is a common complication in patients with cancer, which places them at greater risk for morbidity and mortality. Therefore, risk-appropriate prophylaxis is an essential component for the optimal care of inpatients and outpatients with cancer. Critical to meeting this goal is ensuring that patients get the most effective medication in the correct dose. Body weight has a significant impact on blood volume and drug clearance. Because obesity is a common health problem in industrialized societies, cancer care providers are increasingly likely to treat obese patients in their practice. Obesity is a risk factor common to VTE and many cancers, and may also impact the anticoagulant dose needed for safe and effective prophylaxis. These NCCN Guidelines Insights summarize the data supporting new dosing recommendations for VTE prophylaxis in obese patients with cancer.
Subject(s)
Anticoagulants/administration & dosage , Neoplasms/complications , Obesity/complications , Venous Thromboembolism/drug therapy , Venous Thromboembolism/prevention & control , Adult , Body Mass Index , Body Weight , Dalteparin/administration & dosage , Enoxaparin/administration & dosage , Fondaparinux , Heparin/administration & dosage , Humans , Polysaccharides/administration & dosage , Practice Guidelines as Topic , Renal Insufficiency, Chronic/complications , Venous Thromboembolism/etiologyABSTRACT
Coronary artery disease remains a major health problem worldwide. Since introduction of percutaneous transluminal coronary angioplasty and stents, much progress has been made. Percutaneous coronary intervention, however, has been limited by restenosis (repeat obstruction of arteries that have been previously treated. Introduction of drug-eluting stents (DESs) in April 2003 was a major breakthrough in preventing restenosis. In March 2003, The Society for Cardiovascular Angiography and Interventions (SCAI) published a position statement on the clinical implications of DESs, recommending an evidence-based adoption strategy. Subsequently, in May 2003, SCAI formed a multidisciplinary Drug Eluting Stent (DES) Task Force to address the significant nonclinical ramifications posed by DESs: medicolegal, financial, and access to care. The Task Force included representatives from physician societies, industry, academia, the reimbursement community, and health policy organizations. The resultant report presents analyses, options, and recommendations regarding those nonclinical issues based on the collective experience and knowledge of the Task Force members. The Task Force trusts that this report will be of value to the diverse constituencies involved with introduction of this important new technology.
