Mahé I, Scotté F, Rey J-B, Elalamy I, Lamblin A, Mayeur D, Pernod G
EA 7334, Internal Medicine, Louis-Mourier Hospital, Paris 7 University, AP-HP, 92700 Colombes, France.
Medical Oncology and Supportive Care Unit, Hôpital Européen Georges-Pompidou, 75908 Paris cedex 15, France.
J Med Vasc. 2017 Oct;42(5):255-262. doi: 10.1016/j.jdmv.2017.07.002. Epub 2017 Sep 4.
BACKGROUND/AIM: Long-term use of low-molecular-weight heparins (LMWH) for the treatment of cancer-associated thrombosis (CAT) has been well-established. Conversely, the use of thromboprophylaxis in patients with cancer remains controversial in the absence of homogeneous guidelines. Our aim was to assess the awareness of treatment guidelines and the management of patients with CAT in daily clinical practice.
A national survey based on an open questionnaire developed by a panel of health professionals including specialists in vascular medicine, oncology, supportive care and pharmacy, was proposed on line to 2104 specialists experts in the management of CAT with the objective to collect at least 400 answers. Clinical practice assessment included the treatment of lung adenocarcinoma-associated thrombosis, the use of thromboprophylaxis and factors influencing the management of patients with CAT.
A total of 401 questionnaires were completed by specialists of vascular medicine (68%), oncology (12%) and other (20%). LMWH was the preferred option for over 90% of the participants for the treatment of recent overt proximal pulmonary embolism or deep-vein thrombosis. Up to 70% of the participants considered treatment duration for 6 months and more than 12 months in case of active malignancy. Patient management in the setting of incidental VTE and thromboprophylaxis were heterogeneous in the absence of clear guidance while VTE risk scores would be used by only 14% of participants.
Patients with CAT are properly managed based on clear and consistent guidelines. Patient care is heterogeneous regarding treatment duration beyond 6 months and thromboprophylaxis while VTE risk scores are misused. Identification of referent health care professionals for CAT management and more clear guidelines are required.
背景/目的：长期使用低分子肝素（LMWH）治疗癌症相关血栓形成（CAT）已得到充分证实。相反，在缺乏统一指南的情况下，癌症患者的血栓预防应用仍存在争议。我们的目的是评估日常临床实践中对治疗指南的认知以及CAT患者的管理情况。
基于由包括血管医学、肿瘤学、支持治疗和药学专家在内的一组健康专业人员制定的开放式问卷进行全国性调查，在线向2104名CAT管理专家提出，目标是收集至少400份答案。临床实践评估包括肺腺癌相关血栓形成的治疗、血栓预防的应用以及影响CAT患者管理的因素。
血管医学专家（68%）、肿瘤学专家（12%）和其他专家（20%）共完成了401份问卷。对于近期明显的近端肺栓塞或深静脉血栓形成的治疗，超过90%的参与者首选LMWH。高达70%的参与者认为治疗持续时间为6个月，对于活动性恶性肿瘤患者则超过12个月。在没有明确指导的情况下，偶然发生的静脉血栓栓塞（VTE）和血栓预防的患者管理存在差异，而只有14%的参与者会使用VTE风险评分。
基于明确和一致的指南，CAT患者得到了妥善管理。在治疗持续时间超过6个月和血栓预防方面，患者护理存在差异，同时VTE风险评分被滥用。需要确定CAT管理的参考医疗专业人员并制定更明确的指南。
