VTE Prophylaxis in Patients with Cancer with Dr. Jean Connors
Patients with cancer have a significantly higher risk of VTE. How do we assess risk for developing VTE in patients with cancer? Is there a role for primary VTE prophylaxis in cancer patients? If so what are our treatment options? On this podcast, our expert hematologist Dr Jean Connors delves into these questions and more.
00:54 Introduction 01:16 Clinical scenario 01:55 Why patients with cancer are at higher risk for VTE 03:40 Assessing risk of VTE in patients with cancer 05:30 Khorana risk assessment score – what is it? 09:33 When are patients with cancer at highest risk for VTE? 10:37 Introduction of recent literature on VTE prophylaxis in cancer patients 11:51 VTE prophylaxis guidelines in multiple myeloma vs. other cancers 12:41 AVERT trial summary and discussion 14:10 Criteria for major bleeding in VTE prophylaxis studies 14:45 Cassini Trial summary and discussion 15:10 Contrasting the Cassini and AVERT trials 18:15 Main findings of Cassini trial 19:40 Attrition in the AVERT and Cassini trial 21:07 Contrasting Intention to Treat vs. Per Protocol findings in the Cassini trial 22:19 How will these trials change practice? 23:36 Clinical applications of recent trials in use of DOACs in patients with cancer for VTE prophylaxis 24:53 Challenge of assessing bleeding risk in patients with cancer 26:14 Review of literature and approach to treatment of VTE in cancer patients 30:07 The importance of patient education and anticipatory guidance 30:41 Take away points
The Curbside Consults series complements the foundational information in NEJM R360 Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.
Jean M Connors MD is a clinical hematologist at Brigham and Women’s Hospital and Dana Farber Cancer Institute, the Medical Director of the inpatient Hemostatic Antithrombotic Stewardship program and the outpatient Anticoagulation Management Services, and an assistant professor of medicine at Harvard Medical School. She attended Johns Hopkins School of Medicine, did medical residency at Beth Israel Hospital Boston, and completed fellowship training in hematology-oncology at Brigham and Women’s Hospital and in transfusion medicine at the Harvard Joint Program in Transfusion Medicine.
Amanda Fernandes is a 2018-2019 NEJM editorial fellow.