A worldwide survey to assess the treatment approach of cancer associated venous thromboembolism (CAT)

Introduction: Low-molecular-weight heparin (LWMH) has been recommended as the preferred anticoagulant over vitamin K antagonists (VKAs) for CAT since the CLOT trial was published in 2003. We assessed the current anticoagulation practice of CAT in various countries. Methods: An electronic tool containing 49 questions on different aspects of the treatment of CAT was used for survey; personal links were sent to different specialists. Results: Of the 234 surveys sent between 12/2010 and 3/2012, 141(53 %) were available for analysis. Responses received from Europe, United States (US) and other countries were 58, 35 and 7 %, respectively, including 23 % haematologist, 18 % oncologist, 15 % pulmonologist and 15 % internists. The majority (82 %) use LMWH for long-term anticoagulation as first line. Use of LMWH is significantly higher (p = 0.004) among European respondents (90 %) vs US (69 %). 60 % use therapeutic dose of LMWH, while the remainder dose-reduce after a period of time. For long-term treatment, 44 % prefer LMWH and 10 % VKAs. For recurrent VTE, 44 % of the respondents increased the dose of LWMH, 8.2 % added VKA to LMWH and 30 % would insert IVC filter. Cost, reimbursement and administration of LMWH were the main concerns for not using LMWH. Discussion: With respect to the type of anticoagulant used for the long-term treatment of CAT, a relatively high number of respondent followed guidelines but as expected, a lesser use of LMWH in CAT in US compared to European mainly because of cost and reimbursement