Monday, September 25, 2023
Rates of Venous Thromboembolic Disease According to Risk Score
Predictive Model for Chemotherapy-Associated Venous Thromboembolic Disease
Selected Biomarkers Predictive of Cancer-Associated Thrombosis
Selected Clinical Risk Factors for Cancer-Associated Thrombosis
As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of
an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant
financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial
relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food
and Drug Administration, at first mention and where appropriate in the content.
Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
This activity is intended for primary care clinicians, internists, oncologists, cardiologists, surgeons, and other physicians caring for patients with cancer who may be at risk for VTE.
The goal of this activity is to describe the identification of patients with cancer who may be at high risk for VTE and the role of thromboprophylaxis in these patients.
Upon completion of this activity, participants will be able to:
As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of
an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant
financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial
relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food
and Drug Administration, at first mention and where appropriate in the content.
Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and JNCCN - The Journal of the National Comprehensive Cancer Network. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00
AMA PRA Category 1 Credit(s)™
. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Medscape, LLC staff have disclosed that they have no relevant financial relationships.
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print
out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.
*The credit that you receive is based on your user profile.
CME Released: 7/5/2011
Valid for credit through: 7/5/2012, 11:59 PM EST
processing....
The frequency of venous thromboembolism (VTE) is rising in patients with cancer. VTE contributes to mortality and morbidity, but the risk for VTE can vary widely between individual patients. Clinical risk factors for VTE in cancer include primary site of cancer, use of systemic therapy, surgery, and hospitalization. Biomarkers predictive of VTE include platelet and leukocyte counts, hemoglobin, D-dimer, and tissue factor. A recently validated risk model incorporates 5 easily available variables and can be used clinically to identify patients at increased risk of VTE. In high-risk settings, including surgery and hospitalization, thromboprophylaxis with either unfractionated heparin or low-molecular-weight heparins has been shown to be safe and effective. Recent studies have also suggested a potential benefit for thromboprophylaxis in the ambulatory setting, although criteria for selecting patients for prophylaxis are not currently well defined. This article focuses on recent and ongoing studies of risk assessment and prophylaxis in patients with cancer. (JNCCN 2011;9:789–798)
Patients with cancer, particularly those undergoing active treatment, frequently experience thromboembolic events. These can include deep vein thrombosis (DVT), pulmonary embolism (PE), which together are categorized as venous thromboembolism (VTE), and arterial events, including stroke and myocardial infarction. The frequency of both VTE and arterial events has increased substantially in the past decade,[1] as have trends for venous thromboembolism among hospitalized cancer patients. However, despite the well-known prevalence of VTE in the cancer population, the risk varies widely among subgroups of patients and in individual patients over time.[2,3] Anticoagulants, including low-molecular-weight heparins (LMWHs) and warfarin, have been shown to be safe and effective in preventing VTE in high-risk settings. Understanding the risk for VTE in individual cancer patients or in specific settings therefore becomes especially important to applying targeted thromboprophylaxis.
Knowledge gained within the past decade has improved understanding of risk assessment and prophylaxis of cancer-associated VTE. This article focuses on clinical risk factors, biomarkers, and risk assessment tools that can help clinicians identify cancer patients at risk for VTE, and trials of prophylaxis in various settings, with a particular emphasis on recent developments. VTE is the primary focus of this article; when available, data relevant to arterial events are also discussed.
