单位：[1]Department of Hematology and Bone Marrow Transplantation, RambamHealth Care Campus, Haifa, Israel[2]Foothills Medical Centre and ThrombosisResearch Unit, University of Calgary, Calgary, Canada[3]King’s ThrombosisCentre, Department of Haematological Medicine, King’s College Hospital NHSFoundation Trust, London, UK[4]Thrombosis Research Unit, Department ofMedicine I, Division Hematology, University Hospital ‘Carl Gustav Carus’Dresden, Dresden, Germany[5]King’s Thrombosis Service, Department ofHaematology, King’s College London, London, UK[6]Department of Medicine,McMaster University, Hamilton, Ontario, Canada[7]Thrombosis andAtherosclerosis Research Institute, Hamilton, Ontario, Canada[8]I.M.SechenovFirst Moscow State Medical University, Moscow, Russia[9]Hematology andThrombosis Center, Tenon University Hospital, Sorbonne University, Paris,France[10]Haemostasis and Thrombosis Center, Hospital of Piacenza, Piacenza,Italy[11]Department of Pulmonary and Critical Care Medicine, Center ofRespiratory Medicine, China-Japan Friendship Hospital, National ClinicalResearch Center for Respiratory Diseases, Beijing, China
Background: Clinical practice shows that venous thromboembolism (VTE) presents a substantial burden in medical patients, and awareness and advocacy for its primary and secondary prevention remains inadequate. Specific patient populations, such as those with cancer and the critically ill, show elevated risk for VTE, bleeding or both, and significant gaps in VTE prophylaxis and treatment exist in these groups. Objective: To present current expert insights and evidence on the unmet needs in thromboprophylaxis, and on the treatment of VTE in two high-risk patient groups: patients with cancer and the critically ill. Methodology: To identify specific unmet needs in the management of VTE, a methodology was designed and implemented that assessed gaps in prophylaxis and treatment of VTE through interviews with 44 experts in the field of thrombosis and haemostasis, and through a review of current guidelines and seminal studies to substantiate the insights provided by the experts. The research findings were then analysed, discussed and consolidated by a multidisciplinary group of experts. Results: The gap analysis methodology identified shortcomings in the VTE risk assessment tools, patient stratification approaches for prophylaxis, and the suboptimal use of anticoagulants for primary prophylaxis and treatment. Conclusions: Specifically, patients with cancer need better VTE risk assessment tools to tailor primary thromboprophylaxis to tumour types and disease stages, and the potential for drug-drug interactions needs to be considered. In critically ill patients, unfractionated heparin is not advised as a first-line treatment option, low-molecular weight heparins remain the first choice for prophylaxis in critically ill and cancer patients due to their safety and efficacy profile, and the strength of evidence is increasing for direct oral anticoagulants as a treatment option over low-molecular-weight heparins. Herein we present novel insights and consolidated evidence collected from experts, clinical practice guidelines and original studies on the unmet needs in thromboprophylaxis, and on the treatment of VTE in patients with cancer and the critically ill.
第一作者单位：[1]Department of Hematology and Bone Marrow Transplantation, RambamHealth Care Campus, Haifa, Israel
通讯作者：
推荐引用方式(GB/T 7714)：
Brenner Benjamin,Hull Russell,Arya Roopen,et al.Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in high-risk patient groups: cancer and critically ill[J].THROMBOSIS JOURNAL.2019,17:doi:10.1186/s12959-019-0196-6.
APA：
Brenner, Benjamin,Hull, Russell,Arya, Roopen,Beyer-Westendorf, Jan,Douketis, James...&Zhai, Zhenguo.(2019).Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in high-risk patient groups: cancer and critically ill.THROMBOSIS JOURNAL,17,
MLA：
Brenner, Benjamin,et al."Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in high-risk patient groups: cancer and critically ill".THROMBOSIS JOURNAL 17.(2019)
