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., Fontcuberta Boj J., Font C., Lecumberri R., Monreal M., Muñoz Martín A.J., Otero R., Rubio A., Ruiz-Artacho P., Suarez Fernández C., Colome E., Pérez Segura P.
Publicada:
1 ene 2017
Resumen:
Introduction: 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. Materials and methods: 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. Results: 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. Conclusion: 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. © 2017, Federación de Sociedades Españolas de Oncología (FESEO).
Filiaciones:
Jimenez-Fonseca P.:
Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Carmona-Bayonas A.:
Hematology and Medical Oncology Department, UMU, IMIB, Hospital Universitario Morales Meseguer, Murcia, Spain
Calderon C.:
Clinical Psychology and Psychobiology Department, Faculty of Psychology, University of Barcelona, Barcelona, Spain
Fontcuberta Boj J.:
Unitat d’Hemostàsia i Trombosi, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
Font C.:
Medical Oncology Department, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Universitari Clínic, Barcelona, Spain
Lecumberri R.:
Hemaotology Department, Clínica Universidad de Navarra, Pamplona, Spain
Monreal M.:
Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Muñoz Martín A.J.:
Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
Otero R.:
Medical-Surgical Unit for Respiratory Disease, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Sevilla, Spain
Rubio A.:
Pharmacy Department, Hospital Virgen de la Salud, Toledo, Spain
Ruiz-Artacho P.:
Emergency Department, Hospital Universitario Clínico San Carlos, IdISSC, Madrid, Spain
Suarez Fernández C.:
Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
Colome E.:
Scientific Affairs, LEO Pharma, Barcelona, S.A, Spain
Pérez Segura P.:
Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
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