The Saudi Consensus for the Management of Cancer-Associated Thromboembolism: A Modified Delphi-Based Study.

Mohammed Alsheef, Shouki Bazarbashi, Ashraf Warsi, Feras Alfraih, Abdualkreem Almoomen, Ahmed Osman, Tarek Owaidah
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Abstract

Background  Cancer is a well-known risk factor of preventable thromboembolic disease. This study aims to provide guidance on the prevention and management of cancer-associated thrombosis (CT) that tailors prophylactic and therapeutic options for medical and surgical oncology patients presenting to health care settings in Saudi Arabia. Methods  The present consensus was developed in concordance with the modified Delphi-based approach, which incorporates a face-to-face meeting between two voting rounds to gain experts' feedback on the proposed statements. All experts were either oncologists, hematologists, or hemato-oncologist with an active clinical and research profile in hemato-oncology. Results  The experts highlighted that the comparatively high incidence of inherited thrombophilia among the Saudi population may account for a higher CT burden in the Kingdom than in other parts of the world. However, due to the lack of literature that assesses CT in Saudi Arabia, primary venous thromboembolism prophylaxis should be tailored according to a valid risk assessment of cancer patients and should be implemented in routine practice. For hospitalized medical oncology patients, the experts agreed that prophylaxis with low-molecular-weight heparin (LMWH) should be offered, regardless of the presence of acute illness. For ambulatory medical oncology patients, LMWH or direct oral anticoagulants (DOACs) prophylaxis should be offered for high-risk patients. Concerning surgical patients, they agreed that all oncology patients undergoing surgery should be offered thromboprophylaxis. In terms of secondary prophylaxis, the experts recommended continuing a prophylactic dose of anticoagulant (LMWH or DOAC), for an appropriate period depending on the cancer type and stage. Finally, they also provided a set of statements on management of CT in Saudi Arabia. Conclusion  The present modified Delphi-based study combined the best available evidence and clinical experience with the current health care policies and settings in Saudi Arabia to build a consensus statement on the epidemiology, prevention, and management of CT.

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癌症相关血栓栓塞管理的沙特共识:一项改进的基于delphi的研究。
癌症是众所周知的可预防血栓栓塞性疾病的危险因素。本研究旨在为癌症相关血栓形成(CT)的预防和管理提供指导,为沙特阿拉伯医疗保健机构的内科和外科肿瘤患者量身定制预防和治疗方案。方法采用改进的基于德尔菲的方法,在两轮投票之间进行面对面会议,以获得专家对拟议声明的反馈。所有专家要么是肿瘤学家,血液学家,要么是血液肿瘤学家,在血液肿瘤学方面具有活跃的临床和研究概况。专家强调,沙特人口中相对较高的遗传性血栓发病率可能是沙特王国CT负担高于世界其他地区的原因。然而,由于缺乏评估沙特阿拉伯CT的文献,原发性静脉血栓栓塞预防应根据对癌症患者的有效风险评估进行定制,并应在常规实践中实施。对于住院的内科肿瘤患者,专家们一致认为,无论是否存在急性疾病,都应提供低分子肝素(LMWH)预防。对于门诊内科肿瘤患者,高危患者应给予低分子肝素或直接口服抗凝剂(DOACs)预防。关于外科患者,他们一致认为所有接受手术的肿瘤患者都应该提供血栓预防。在二级预防方面,专家建议根据癌症类型和分期,继续使用预防性剂量的抗凝剂(低分子肝素或DOAC)。最后,他们还提供了一套关于沙特阿拉伯CT管理的声明。结论本改进的德尔菲基础研究结合了现有的最佳证据和临床经验以及沙特阿拉伯目前的卫生保健政策和环境,建立了关于CT流行病学、预防和管理的共识声明。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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