Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented
Exocrine pancreatic ductal adenocarcinoma, simply referred to as pancreatic cancer (PC) has the worst prognosis of any malignancy. Despite recent advances in the use of adjuvant chemotherapy in PC, the prognosis remains poor, with fewer than 8% of patients being alive at 5 years after diagnosis. The...
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doaj-c273b696fd504e169160d1c83ef984b92020-11-25T02:15:07ZengMDPI AGCancers2072-66942020-03-0112361810.3390/cancers12030618cancers12030618Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be ImplementedDominique Farge0Barbara Bournet1Thierry Conroy2Eric Vicaut3Janusz Rak4George Zogoulous5Jefferey Barkun6Mehdi Ouaissi7Louis Buscail8Corinne Frere9Institut Universitaire d’Hématologie, Université de Paris, EA 3518, F-75010 Paris, FranceUniversity of Toulouse, F-31059 Toulouse, FranceInstitut de Cancérologie de Lorraine, Department of Medical Oncology, Université de Lorraine, APEMAC, EA4360, F-54519 Vandoeuvre-lès-Nancy, FranceDepartment of Biostatistics, Université de Paris, F-75010 Paris, FranceMcGill University and the Research Institute of the McGill University Health Centre, Montreal, Québec, QC H4A 3J1, CanadaMcGill University and the Research Institute of the McGill University Health Centre, Montreal, Québec, QC H4A 3J1, CanadaMcGill University and the Research Institute of the McGill University Health Centre, Montreal, Québec, QC H4A 3J1, CanadaDepartment of Digestive, Oncological, Endocrine, and Hepatic Surgery, and Hepatic Transplantation, Trousseau Hospital, CHRU Trousseau, F-37170 Chambray-les-Tours, FranceUniversity of Toulouse, F-31059 Toulouse, FranceInstitute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM UMRS_1166, GRC 27 GRECO, F-75013 Paris, FranceExocrine pancreatic ductal adenocarcinoma, simply referred to as pancreatic cancer (PC) has the worst prognosis of any malignancy. Despite recent advances in the use of adjuvant chemotherapy in PC, the prognosis remains poor, with fewer than 8% of patients being alive at 5 years after diagnosis. The prevalence of PC has steadily increased over the past decades, and it is projected to become the second-leading cause of cancer-related death by 2030. In this context, optimizing and integrating supportive care is important to improve quality of life and survival. Venous thromboembolism (VTE) is a common but preventable complication in PC patients. VTE occurs in one out of five PC patients and is associated with significantly reduced progression-free survival and overall survival. The appropriate use of primary thromboprophylaxis can drastically and safely reduce the rates of VTE in PC patients as shown from subgroup analysis of non-PC targeted placebo-controlled randomized trials of cancer patients and from two dedicated controlled randomized trials in locally advanced PC patients receiving chemotherapy. Therefore, primary thromboprophylaxis with a Grade 1B evidence level is recommended in locally advanced PC patients receiving chemotherapy by the International Initiative on Cancer and Thrombosis clinical practice guidelines since 2013. However, its use and potential significant clinical benefit continues to be underrecognized worldwide. This narrative review aims to summarize the main recent advances in the field including on the use of individualized risk assessment models to stratify the risk of VTE in each patient with individual available treatment options.https://www.mdpi.com/2072-6694/12/3/618pancreatic cancervenous thromboembolismthromboprophylaxislow-molecular weight heparindirect oral anticoagulantsurvival |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Dominique Farge Barbara Bournet Thierry Conroy Eric Vicaut Janusz Rak George Zogoulous Jefferey Barkun Mehdi Ouaissi Louis Buscail Corinne Frere |
spellingShingle |
Dominique Farge Barbara Bournet Thierry Conroy Eric Vicaut Janusz Rak George Zogoulous Jefferey Barkun Mehdi Ouaissi Louis Buscail Corinne Frere Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented Cancers pancreatic cancer venous thromboembolism thromboprophylaxis low-molecular weight heparin direct oral anticoagulant survival |
author_facet |
Dominique Farge Barbara Bournet Thierry Conroy Eric Vicaut Janusz Rak George Zogoulous Jefferey Barkun Mehdi Ouaissi Louis Buscail Corinne Frere |
author_sort |
Dominique Farge |
title |
Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented |
title_short |
Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented |
title_full |
Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented |
title_fullStr |
Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented |
title_full_unstemmed |
Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented |
title_sort |
primary thromboprophylaxis in pancreatic cancer patients: why clinical practice guidelines should be implemented |
publisher |
MDPI AG |
series |
Cancers |
issn |
2072-6694 |
publishDate |
2020-03-01 |
description |
Exocrine pancreatic ductal adenocarcinoma, simply referred to as pancreatic cancer (PC) has the worst prognosis of any malignancy. Despite recent advances in the use of adjuvant chemotherapy in PC, the prognosis remains poor, with fewer than 8% of patients being alive at 5 years after diagnosis. The prevalence of PC has steadily increased over the past decades, and it is projected to become the second-leading cause of cancer-related death by 2030. In this context, optimizing and integrating supportive care is important to improve quality of life and survival. Venous thromboembolism (VTE) is a common but preventable complication in PC patients. VTE occurs in one out of five PC patients and is associated with significantly reduced progression-free survival and overall survival. The appropriate use of primary thromboprophylaxis can drastically and safely reduce the rates of VTE in PC patients as shown from subgroup analysis of non-PC targeted placebo-controlled randomized trials of cancer patients and from two dedicated controlled randomized trials in locally advanced PC patients receiving chemotherapy. Therefore, primary thromboprophylaxis with a Grade 1B evidence level is recommended in locally advanced PC patients receiving chemotherapy by the International Initiative on Cancer and Thrombosis clinical practice guidelines since 2013. However, its use and potential significant clinical benefit continues to be underrecognized worldwide. This narrative review aims to summarize the main recent advances in the field including on the use of individualized risk assessment models to stratify the risk of VTE in each patient with individual available treatment options. |
topic |
pancreatic cancer venous thromboembolism thromboprophylaxis low-molecular weight heparin direct oral anticoagulant survival |
url |
https://www.mdpi.com/2072-6694/12/3/618 |
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