Specialist GP Nikki Vadgama provides some tips to make your next paediatric eczema consult easier. She includes a review of new guidelines, resources, websites and medications for paediatric eczema management
Should you give primary prophylaxis for venous thromboembolism to patients with cancer?
Vault Navigation
Should you give primary prophylaxis for venous thromboembolism to patients with cancer?
What is the efficacy and safety of primary thromboprophylaxis for venous thromboembolism in ambulatory patients receiving chemotherapy for cancer?
In ambulatory patients with cancer, primary thromboprophylaxis with direct factor Xa inhibitors may reduce the incidence of symptomatic venous thromboembolism (VTE; low‐certainty evidence) and probably increases the risk of major bleeding (moderate‐certainty evidence) when compared with placebo.
Low‐molecular‐weight heparin (LMWH) reduces symptomatic VTE, with 37 participants requiring prophylaxis to prevent 1 event (high‐certainty evidence). This benefit comes at the cost of a higher incidence of major bleeding – for each 144 participants treated, 1 event is expected to occur when compared against placebo or no thromboprophylaxis (moderate‐certainty evidence).
Evidence for the use of thromboprophylaxis with anticoagulants other than direct factor Xa inhibitors and LMWH is limited.
No randomised controlled trials evaluated fondaparinux, dabigatran, edoxaban or mechanical interventions. Comorbidities predisposing to bleeding, which often represent an exclusion criterion in randomised controlled trials on anticoagulants, might result in a greater number of major bleeding complications and limit the use of thromboprophylaxis in routine clinical practice.
Additional concerns may be the use of thromboprophylaxis with apixaban or rivaroxaban in some types of cancers, such as those of the gastrointestinal or genitourinary tracts, which were more prone to bleed in the studies with direct oral anticoagulants.
VTE often complicates the clinical course of cancer. The risk is further increased by chemotherapy, but the trade‐off between safety and efficacy of primary thromboprophylaxis in patients with cancer treated with chemotherapy is uncertain.
Rutjes AWS, et al. Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy. Cochrane Database Syst Rev 2020, Issue 12. Art. No.: CD008500. DOI: 10.1002/14651858.CD008500.pub5. This review contains 32 trials with a total of 15,678 participants.