2 responses to “Thromboprophylaxis in ambulatory cancer patients”

  1. Do most chemo regimens have the same VTE risk or does it vary by tumour site/regimen? What bleeding risk tool was used in these studies?

  2. To my knowledge there has not been large trial looking at the risk of different chemotherapy regimens and VTE risk. Likely due to cancer and chemo being very heterogeneous. The major VTE risk scores have looked at cancer types I suspect as it is easier to model and validate the scoring system. AVERT in their supplementary appendix have a table showing what chemotherapy the patients were on. Both the placebo and treatment arm have similar amount of patients in each type of chemotherapy regimen.

    For bleeding risk tools both trials did not use a tool to risk stratify patients. However, both trials attempted to exclude patients at higher risk of bleeding. For AVERT they excluded: hepatic disease with coagulopathy, acute leukemia, or myeloproliferative neoplasm; a planned stem-cell transplantation, a life expectancy of less than 6 months, renal insufficiency with a glomerular filtration rate of less than 30, or a platelet count of less than 50.

    For the CASSINI trial they excluded patients with a diagnosis of brain tumour, hematologic malignancy excluding lymphoma, bleeding diathesis/active bleeding, life expectancy less the 6 months and high risk for bleeding. Looking at both the trial design paper and NEJM publication what constituted high risk of bleeding is unclear.

    Overall, when starting a patient on anticoagulation there are many scores that exist to help guide the decision making but ultimately it comes down to clinical judgment

    I hope that helps!

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