Eun-Ju Lee1, B Douglas Smith2, Jessica W Merrey3, Alfred I Lee1, Nikolai A Podoltsev1, Lisa Barbarotta1, Mark R Litzow4, Thomas Prebet1, Selina M Luger5, Steven Gore1, Michael B Streiff3, Amer M Zeidan6. 1. Section of Hematology, Department of Internal Medicine, Yale University, New Haven, CT. 2. Department of Oncology, Johns Hopkins University, Baltimore, MD. 3. Department of Medicine, Johns Hopkins University, Baltimore, MD. 4. Department of Medicine, Mayo Clinic, Rochester, MN. 5. Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA. 6. Section of Hematology, Department of Internal Medicine, Yale University, New Haven, CT. Electronic address: amer.zeidan@yale.edu.
Abstract
BACKGROUND: Venous thromboembolism (VTE) occurs in 2% to 12% of patients with acute leukemia (AL) despite disease- and therapy-associated thrombocytopenia, and it can be associated with significant morbidity and mortality. Because of the few high-quality studies, there are no evidence-based guidelines for VTE prophylaxis in this patient population. We sought to determine the spectrum of practice regarding prevention of VTE in patients with AL during induction and consolidation therapies. METHODS: We conducted a 19-question Web-based survey directed at North American providers caring for these patients. One hundred fifty-one of 215 responses received were eligible for analysis, with a response rate of 20.9% among physicians who treated leukemias. RESULTS: Overall, 47% and 45% of providers reported using pharmacologic VTE prophylaxis during induction and consolidation phases, respectively. Approximately 15% of providers did not provide any VTE prophylaxis, while 36% used mechanical methods and ambulation. Among providers who did not recommend pharmacologic prophylaxis, the most commonly cited reasons were the perceived high risk of bleeding (51%), absence of data supporting use (38%), and perceived low risk of VTE (11%). CONCLUSION: Large, prospective studies are needed to define the safest and most effective approach to VTE prevention in patients with AL.
BACKGROUND:Venous thromboembolism (VTE) occurs in 2% to 12% of patients with acute leukemia (AL) despite disease- and therapy-associated thrombocytopenia, and it can be associated with significant morbidity and mortality. Because of the few high-quality studies, there are no evidence-based guidelines for VTE prophylaxis in this patient population. We sought to determine the spectrum of practice regarding prevention of VTE in patients with AL during induction and consolidation therapies. METHODS: We conducted a 19-question Web-based survey directed at North American providers caring for these patients. One hundred fifty-one of 215 responses received were eligible for analysis, with a response rate of 20.9% among physicians who treated leukemias. RESULTS: Overall, 47% and 45% of providers reported using pharmacologic VTE prophylaxis during induction and consolidation phases, respectively. Approximately 15% of providers did not provide any VTE prophylaxis, while 36% used mechanical methods and ambulation. Among providers who did not recommend pharmacologic prophylaxis, the most commonly cited reasons were the perceived high risk of bleeding (51%), absence of data supporting use (38%), and perceived low risk of VTE (11%). CONCLUSION: Large, prospective studies are needed to define the safest and most effective approach to VTE prevention in patients with AL.
Authors: Stephen Couban; Michael Goodyear; Margot Burnell; Sean Dolan; Parveen Wasi; David Barnes; Darlene Macleod; Erica Burton; Pantelis Andreou; David R Anderson Journal: J Clin Oncol Date: 2005-03-14 Impact factor: 44.544
Authors: Sophie Ziegler; Wolfgang R Sperr; Paul Knöbl; Stephan Lehr; Ansgar Weltermann; Ulrich Jäger; Peter Valent; Klaus Lechner Journal: Thromb Res Date: 2005 Impact factor: 3.944
Authors: Maria Ilaria Del Principe; Francesco Buccisano; Luca Maurillo; Daniela Venditti; Mariagiovanna Cefalo; Chiara Sarlo; Luigi Di Caprio; Ambra Di Veroli; Daniela Nasso; Eleonora Ceresoli; Massimiliano Postorino; Fabio Di Piazza; Giulio Colandrea; Fabio Conti; Giovanni Del Poeta; Sergio Amadori; Adriano Venditti Journal: Thromb Res Date: 2013-08-16 Impact factor: 3.944
Authors: Agnes Y Y Lee; Mark N Levine; Ross I Baker; Chris Bowden; Ajay K Kakkar; Martin Prins; Frederick R Rickles; Jim A Julian; Susan Haley; Michael J Kovacs; Michael Gent Journal: N Engl J Med Date: 2003-07-10 Impact factor: 91.245
Authors: Khanh Vu; Nhiem V Luong; Julie Hubbard; Ali Zalpour; Stefan Faderl; Deborah A Thomas; Daisy Yang; Hagop Kantarjian; Michael H Kroll Journal: Cancer Med Date: 2014-12-08 Impact factor: 4.452
Authors: Rachael F Grace; Daniel J DeAngelo; Kristen E Stevenson; Donna Neuberg; Stephen E Sallan; Yasser R Abou Mourad; Julie Bergeron; Matthew D Seftel; Caroline Kokulis; Jean M Connors Journal: J Thromb Thrombolysis Date: 2018-02 Impact factor: 2.300
Authors: Ryuhei So; Kiyomi Shinohara; Takuya Aoki; Yasushi Tsujimoto; Aya M Suganuma; Toshi A Furukawa Journal: J Med Internet Res Date: 2018-02-08 Impact factor: 5.428