Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant concern for patients with cancer. The annual incidence of VTE in patients with cancer is estimated to be between 0.5% to 20%, depending on the type of cancer. Treatment of cancer-associated VTE can be complicated due to increased risk of bleeding in these patients and potential drug-drug interactions with chemotherapy. Traditionally, various guidelines have recommended low molecular weight heparin (LMWH) as the preferred agent for treatment of cancer-associated VTE. Current guidelines recommend select direct-oral anticoagulants (DOACs) as reasonable treatment options, although they differ in their recommendations for specific DOACs. Recent literature, including the Hokusai VTE Cancer, SELECT-D, and ADAM-VTE trials provide insight into the safety and efficacy of select DOACs for treatment of cancer-associated VTE as well as which patients may be most likely to benefit from DOACs over LMWH.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Discuss cancer-associated VTE treatment guidelines.
• Describe current evidence for use of direct oral anticoagulants.
• Identify appropriate treatment options for cancer-associated VTE

Pharmacy Continuing Education Credits This program is sponsored by the University of Pittsburgh Center for Continuing Education in the Health Sciences. The University of Pittsburgh Center for Continuing Education in the Health Sciences is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a Provider of continuing pharmacy education. The assigned universal program number(s) is JA4008223-0000-23-060-H01-P. This module is a webcast of an ACPE approved live presentation. The minimum credit awarded for this module (.75 contact hour) is determined by the length of the entire live presentation inclusive of the post-test.

Suggested Additional Reading:

1. American Heart Association. What is Venous Thromboembolism (VTE)? http://www.heart.org/HEARTORG/Conditions/VascularHealth/VenousThromboembolism/What-is-Venous-Thromboembolism-VTE_UCM_479052_Article.jsp#.WniiypM-eL4. Last reviewed March 2017. Accessed February 7, 2020.
2. Ay C, Beyer-Westendorf J, Pabinger I. Treatment of cancer-associated venous thromboembolism in the age of direct oral anticoagulants. Ann Oncol. 2019;30(6):897-907.
3. Streiff MB, Holmstrom B, Angelini D, et al. Cancer-associated venous thromboembolic disease (version 1.2019). National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology.
4. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315–352.
5. https://www.nccn.org/professionals/physician_gls/pdf/vte.pdf. Accessed January 18, 2020.
6. Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2020;38(5):496–520.
7. Raskob GE, van EsN, Verhamme P, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378(7):615-624.
8. Young AM, Marshall A, Thirlwall J, et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018;36(20):2017–2023.
9. McBane RD 2nd, Wysokinski WE, Le-Rademacher JG, et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: The ADAM VTE trial. J Thromb Haemost. 2020;18(2):411–421.
10. Agnelli G, Becattini C, Bauersachs R, et al. Apixaban versus dalteparin for the treatment of acute venous thromboembolism in patients with cancer: The Caravaggio Study. Thromb Haemost. 2018;118(9):1668-1678.