Craven Philip, Daly Ciara, Sikotra Nisha, Clay Tim, Gabbay Eli
Department of Respiratory Medicine, St John of God Healthcare, Subiaco, Australia.
Bendat Respiratory Research and Development Fund, St John of God Healthcare, Subiaco, Australia.
Pulm Circ. 2021 Jan 7;11(1):2045894020953841. doi: 10.1177/2045894020953841. eCollection 2021 Jan-Mar.
Twenty percent of patients with Cancer Associated Thrombosis receive an inferior vena cava filter annually. Insertion is guided by practice guidelines, which do not specify or discuss the use of inferior vena cava filters in malignancy. Adherence to these guidelines is known to be variable. We aimed to see if there was consistent management of venous thromboembolism among Medical Oncologists/Haematologists and Respiratory Physicians, with respect to inferior vena cava filter use in the setting of suspected and confirmed malignancy. Medical Oncologists, Haematologists and Respiratory Physicians were surveyed with four theoretical cases. Case 1 concerns a patient who develops a pulmonary embolism following spinal surgery. Cases 2 and 4 explore the use of inferior vena cava filters in the setting of malignancy. Case 3 covers the role of inferior vena cava filters in recurrent thrombosis despite systemic anticoagulation. There were 56 responses, 32 (57%) Respiratory Physicians and 24 (43%) Haematologists/Oncologists. Respiratory Physicians were significantly more likely to insert an inferior vena cava filter in case 1 ( = 0.04) whilst Haematologists/Medical Oncologists were more likely to insert an inferior vena cava filter in case 3 ( = 0.03). No significant differences were found in cases 2 and 4. There were significant disparities in terms of type and timing of anticoagulation. Consistency of recommendations with guidelines was variable likely in part because guidelines are themselves inconsistent. The heterogeneity in responses highlights the variations in venous thromboembolism management, especially in Cancer Associated Thrombosis. International Societies should consider addressing inferior vena cava filter use specifically in the setting of Cancer Associated Thrombosis. Collaboration between interested specialities would assist in developing consistent, evidence-based guidelines for the use of inferior vena cava filters in the management of venous thromboembolism.
每年有20%的癌症相关性血栓形成患者接受下腔静脉滤器植入。植入操作遵循实践指南，但这些指南并未明确规定或讨论下腔静脉滤器在恶性肿瘤中的使用。已知对这些指南的遵循情况存在差异。我们旨在探讨在疑似和确诊恶性肿瘤的情况下，肿瘤内科医生/血液科医生和呼吸内科医生在静脉血栓栓塞管理方面，对于下腔静脉滤器的使用是否存在一致的处理方法。我们用四个理论病例对肿瘤内科医生、血液科医生和呼吸内科医生进行了调查。病例1涉及一名脊柱手术后发生肺栓塞的患者。病例2和病例4探讨了下腔静脉滤器在恶性肿瘤情况下的使用。病例3涵盖了尽管进行了全身抗凝治疗但仍反复发生血栓形成时下腔静脉滤器的作用。共收到56份回复，其中32份（57%）来自呼吸内科医生，24份（43%）来自血液科医生/肿瘤内科医生。在病例1中，呼吸内科医生更有可能植入下腔静脉滤器（P = 0.04），而在病例3中，血液科医生/肿瘤内科医生更有可能植入下腔静脉滤器（P = 0.03）。在病例2和病例4中未发现显著差异。在抗凝类型和时机方面存在显著差异。与指南的建议一致性存在差异，这可能部分是因为指南本身就不一致。回复的异质性突出了静脉血栓栓塞管理的差异，尤其是在癌症相关性血栓形成方面。国际学会应考虑专门针对癌症相关性血栓形成情况下下腔静脉滤器的使用制定相关措施。相关专业之间的合作将有助于制定关于下腔静脉滤器在静脉血栓栓塞管理中使用的一致的、基于证据的指南。
