RESUMEN
Introduction. Decision-making in cancer-related venous thromboembolism (VTE) is often founded on scant lines of evidence and weak recommendations. The aim of this work is to evaluate the percentage of agreement surrounding a series of statements about complex, clinically relevant, and highly uncertain aspects to formulate explicit action guidelines. Materials and methods. Opinions were based on a structured questionnaire with appropriate scores and were agreed upon using a Delphi method. Questions were selected based on a list of recommendations with low evidence from the Spanish Society of Oncology Clinical Guideline for Thrombosis. The questionnaire was completed in two iterations by a multidisciplinary panel of experts in thrombosis. Results. Of the 123 statements analyzed, the panel concurred on 22 (17%) and another 81 (65%) were agreed on by qualified majority, including important aspects of long-term and prolonged anticoagulation, major bleeding and rethrombosis management, treatment in special situations, catheter-related thrombosis and thromboprophylaxis. Among them, the panelists agreed the incidental events should be equated to symptomatic ones, long-term and extended use of full-dose low-molecular weight heparin, and concluded that the Khorana score is not sensitive enough to uphold an effective thromboprophylaxis strategy. Conclusion. Though the level of consensus varied depending on the scenario presented, overall, the iterative process achieved broad agreement as to the general treatment principles of cancer-associated VTE. Clinical validation of these statements in genuine practice conditions would be useful (AU)
No disponible
Asunto(s)
Humanos , Trombosis/complicaciones , Consenso , Neoplasias/prevención & control , Neoplasias/terapia , Toma de Decisiones , Profilaxis Antibiótica/métodos , Encuestas y Cuestionarios , Técnica Delphi , Sociedades Médicas/normas , Trombosis/tratamiento farmacológico , Anticoagulantes/uso terapéuticoRESUMEN
INTRODUCTION: Decision-making in cancer-related venous thromboembolism (VTE) is often founded on scant lines of evidence and weak recommendations. The aim of this work is to evaluate the percentage of agreement surrounding a series of statements about complex, clinically relevant, and highly uncertain aspects to formulate explicit action guidelines. MATERIALS AND METHODS: Opinions were based on a structured questionnaire with appropriate scores and were agreed upon using a Delphi method. Questions were selected based on a list of recommendations with low evidence from the Spanish Society of Oncology Clinical Guideline for Thrombosis. The questionnaire was completed in two iterations by a multidisciplinary panel of experts in thrombosis. RESULTS: Of the 123 statements analyzed, the panel concurred on 22 (17%) and another 81 (65%) were agreed on by qualified majority, including important aspects of long-term and prolonged anticoagulation, major bleeding and rethrombosis management, treatment in special situations, catheter-related thrombosis and thromboprophylaxis. Among them, the panelists agreed the incidental events should be equated to symptomatic ones, long-term and extended use of full-dose low-molecular weight heparin, and concluded that the Khorana score is not sensitive enough to uphold an effective thromboprophylaxis strategy. CONCLUSION: Though the level of consensus varied depending on the scenario presented, overall, the iterative process achieved broad agreement as to the general treatment principles of cancer-associated VTE. Clinical validation of these statements in genuine practice conditions would be useful.
Asunto(s)
Anticoagulantes/uso terapéutico , Neoplasias/complicaciones , Guías de Práctica Clínica como Asunto/normas , Trombosis/prevención & control , Medicina Basada en la Evidencia , Humanos , Oncología Médica , Pronóstico , Medición de Riesgo , Trombosis/etiologíaAsunto(s)
Expresión Génica/genética , Enfermedades Renales/diagnóstico por imagen , Mutación Puntual/genética , Protrombina/genética , Trombosis de la Vena/genética , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Femenino , Humanos , Recién Nacido , Enfermedades Renales/genética , Radiografía , Arteria Renal/diagnóstico por imagen , Ultrasonografía Doppler , Venas Cavas/diagnóstico por imagen , Venas Cavas/patología , Trombosis de la Vena/diagnóstico por imagenRESUMEN
No disponible