Prophylaxis and treatment of venous thromboembolism in cancer patients: a systemic review and critical appraisal of clinical practice guidelines
Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer and many organizations have published guidelines to help clinicians in prophylaxis and treatment with VTE in cancer patients. However, the quality of different guidelines remains unclear. In this study, we aimed to explore score and provide a whole picture of the current guidelines. Clinical guidelines and consensus statements in English to July 2017 were searched using MEDLINE via PubMed, EMBASE and some websites of guideline organizations. The guidelines containing recommendations on the prophylaxis and treatment with VTE in cancer patients were included. Three reviewers appraised the quality of the included guidelines by using Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Six domains with 23 items were appraised and standardized averages were calculated as the final scores in every domain. Of 2,335 citations identified, 13 guidelines were included in this study. Associazione Italiana di Oncologia Medica (AIOM), British Committee for Standards in Haematology (BCSH) and French national guideline were regard as “recommended for use with some modification” while the others were “strongly recommended for use in practice”. Most included guidelines scored high in domain 1 (scope and purpose) and domain 2 (stakeholder involvement), but scored poorly in domain 5 (applicability). The recommendations were consistent in general among the included guidelines. Low molecular weight heparin (LMWH) was the major choice for the prophylaxis and treatment but the duration for the long-term treatment for VTE was controversy and the guidelines with high quality tended to recommend 3 months. Apart from the BCSH guidelines, direct acting oral anticoagulants (DOACs) were not recommended on prophylaxis or treatment. The guidelines on VTE in cancer patients were of relative high quality. More effort is needed to decrease the gap between the practice and guideline. DOACs seem to be potential candidate when clinicians are reluctant to use LMWH, but more researches must be performed.