Specialty-based approaches to acute treatment and secondary prevention of venous thromboembolism in patients with cancer: a nationwide survey

Background / Introduction

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in patients with cancer. Although international guidelines provide recommendations for acute treatment and secondary prevention, real-world implementation may vary across medical specialties, particularly in complex clinical scenarios.

Purpose

To evaluate real-world, specialty-based approaches to acute treatment and secondary prevention of VTE in patients with cancer.

Methods

We conducted a nationwide, cross-sectional survey among physicians in Turkiye using a structured questionnaire. The survey focused on VTE management beyond primary prevention and included questions on acute-phase anticoagulant choice (first 10 days), secondary prevention duration and agent selection, criteria for extending anticoagulation up to 12 months, management of recurrent events under anticoagulation, and challenging clinical scenarios such as brain tumours, neurosurgical planning, severe renal impairment, thrombocytopenia, and pregnancy. Specialty-based comparisons were performed using chi-square or Fisher’s exact tests, as appropriate.

Results

A total of 84 physicians participated, including 50 cardiologists (59.5%) and 34 oncologists (40.5%). Low-molecular-weight heparin (LMWH) was the most frequently selected anticoagulant for acute VTE treatment (72.6%), with no significant difference between specialties. Following the acute phase, secondary prevention duration was most commonly individualised (56.0%).

Marked inter-specialty differences were observed in secondary prevention agent selection with cardiologists predominantly favouring direct oral anticoagulants and oncologists more frequently preferring LMWH. Extension of secondary prophylaxis to 12 months was mainly driven by persistence of VTE risk factors, such as active cancer or ongoing anticancer therapy (65.1%).

Approaches to recurrent VTE under anticoagulation were heterogeneous. In patients with brain tumours scheduled for neurosurgery, prophylaxis strategies differed significantly between specialties (p≈0.02). In severe renal impairment, LMWH and unfractionated heparin were preferred, whereas use of direct oral anticoagulants was limited. In pregnancy, LMWH was overwhelmingly favoured (78.3%). Notably, 94.0% of respondents reported a need to further update their knowledge on VTE prevention and treatment in cancer. All of data presented in Table.

Conclusion(s)

LMWH remains the cornerstone of acute VTE treatment in patients with cancer, while secondary prevention strategies, particularly anticoagulant selection, show substantial specialty-based variability. Significant differences in selected high-risk scenarios and the high demand for education highlight an unmet need for multidisciplinary, guideline-aligned approaches to optimise VTE management in cardio-oncology practice.Table.