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Treatment Algorithm in CAT: Canadian Expert Consensus Published in Current Oncology

Thrombosis experts from across the country have come together to develop a treatment algorithm for Cancer-associated Thrombosis (CAT) which has just been published in Current Oncology http://thrombosiscan.info/CAT-Consensus-Pub

In the cancer patient population, anticoagulant therapy management for venous thromboembolism (VTE) is complex due to an increased risk of recurrent VTE and major bleeding compared to VTE patients without cancer. Based on patient-related risk factors as well as the type of tumour, cancer stage and treatments for cancer, the underlying risk for recurrent VTE and major bleeding complications will vary. Current clinical practice guidelines suggest using low-molecular-weight heparin (LMWH) monotherapy for the treatment of CAT. However, in light of new clinical evidence about the use of direct oral anticoagulants (DOACs) in CAT management, it becomes imperative to assess the patient for the best individualized treatment option.

The committee developed the treatment algorithm to provide guidance on the selection of anticoagulation therapy in cancer patients with deep vein thrombosis (DVT) or pulmonary embolism (PE). The treatment algorithm proposes that patients considered at high risk of bleeding, with active gastrointestinal or urothelial cancer, and/or on concomitant medications that would lead to potentially serious drug-drug interactions with Direct Oral Anticoagulants (DOACs) should be treated with extended duration, therapeutic dose Low-Molecular-Weight Heparin (LMWH), while patients not meeting these criteria can be treated with DOACs.

In the month of November, Thrombosis Canada presented four live webinars where members of the committee including Dr Agnes Lee, Dr Cynthia Wu and Dr Marc Carrier reviewed the consensus process and data that was used to create the resulting treatment algorithm. The webinars have been archived and can be accessed on our site here: https://thrombosiscanada.ca/webinars-cat-treatment/