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CC BY-NC-ND 4.0 · TH Open 2023; 07(01): e14-e29
DOI: 10.1055/s-0042-1758856
Original Article

The Saudi Consensus for the Management of Cancer-Associated Thromboembolism: A Modified Delphi-Based Study

Mohammed Alsheef 
1   Department of Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
,
Shouki Bazarbashi
2   College of Medicine, Al-Faisal University Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
,
Ashraf Warsi
3   Department of Haematology, Ministry of National Guard-Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
4   Department of Medicine, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
,
Feras Alfraih
2   College of Medicine, Al-Faisal University Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
,
Abdualkreem Almoomen
5   Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
,
Ahmed Osman
6   Pfizer Pharmaceuticals, Riyadh, Saudia Arabia
,
Tarek Owaidah
7   Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
› Author Affiliations Funding The authors received no financial support for the research, authorship, and/or publication of this article. Medical writing support and article processing charges have been funded by Pfizer.
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Abstract

Background Cancer is a well-known risk factor of preventable thromboembolic disease. This study aims to provide guidance on the prevention and management of cancer-associated thrombosis (CT) that tailors prophylactic and therapeutic options for medical and surgical oncology patients presenting to health care settings in Saudi Arabia.

Methods The present consensus was developed in concordance with the modified Delphi-based approach, which incorporates a face-to-face meeting between two voting rounds to gain experts' feedback on the proposed statements. All experts were either oncologists, hematologists, or hemato-oncologist with an active clinical and research profile in hemato-oncology.

Results The experts highlighted that the comparatively high incidence of inherited thrombophilia among the Saudi population may account for a higher CT burden in the Kingdom than in other parts of the world. However, due to the lack of literature that assesses CT in Saudi Arabia, primary venous thromboembolism prophylaxis should be tailored according to a valid risk assessment of cancer patients and should be implemented in routine practice. For hospitalized medical oncology patients, the experts agreed that prophylaxis with low-molecular-weight heparin (LMWH) should be offered, regardless of the presence of acute illness. For ambulatory medical oncology patients, LMWH or direct oral anticoagulants (DOACs) prophylaxis should be offered for high-risk patients. Concerning surgical patients, they agreed that all oncology patients undergoing surgery should be offered thromboprophylaxis. In terms of secondary prophylaxis, the experts recommended continuing a prophylactic dose of anticoagulant (LMWH or DOAC), for an appropriate period depending on the cancer type and stage. Finally, they also provided a set of statements on management of CT in Saudi Arabia.

Conclusion The present modified Delphi-based study combined the best available evidence and clinical experience with the current health care policies and settings in Saudi Arabia to build a consensus statement on the epidemiology, prevention, and management of CT.

Keywords

cancer-associated thrombosis - venous thromboembolism - thromboprophylaxis - consensus - anticoagulant - LMWH - DOAC - Saudi Arabia

Disclosures

The data in this manuscript was based on the outcomes of a series of advisory boards. All authors made a significant contribution to the work reported, whether that is in the conception, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. This work was supported by Pfizer Emerging Markets. Pfizer (Saudi Arabia) provided funding for the advisory board meetings and editorial assistance in the development of the manuscript. Neither honoraria nor payments were made for authorship.




Publication History

Received: 30 June 2022

Accepted: 10 October 2022

Article published online:
07 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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