SSC Subcommittee on Cancer-Associated Thrombosis & Hemostasis

Dear Health Care Practitioner,

Background

The peri-procedural management of direct oral anticoagulants (DOACs) in persons with cancer (PWC) undergoing tunneled or port central venous catheter (CVC) insertion is a common but understudied clinical problem, with conflicting management advice from guidelines and resultant uncertainty for best practices. Data from prospective studies assessing peri-procedural DOAC management exist; however, these data pertain to procedures in the general population. These management strategies may not be applicable to PWC because (1) although CVC insertion is a low risk, image-guided specialized procedure, (2) PWC are at considerably higher risk of peri-procedural bleeding and thrombosis than non-PWC. It is not surprising, therefore, that guideline recommendations and current practices vary widely. We propose a survey of health care practitioners to gauge their practices and comfort regarding peri-procedural DOAC management for CVC insertion in PWC.

We are designing an investigator initiated randomized controlled trial comparing continued to interrupted DOAC for CVC insertion in PWC. We are asking for your input through this survey to better understand current practices of peri-procedural DOAC management for CVC insertion in PWC and help guide trial design.

You are invited to take part in this study survey because you are a health care practitioner that is involved in peri-procedural anticoagulation and/or CVC insertion. 

Survey

This study will look at your current practices of peri-procedural DOAC management for CVC insertion in PWC and your thoughts on a clinical trial comparing continued to interrupted DOAC for CVC insertion in PWC. The aim of this research is to gain insight into current practices and help design a clinical trial.

Your participation in this survey is completely voluntary.

If you agree to participate, you will be asked to complete an online survey. The survey is 14 to 18 questions long, and is estimated to take no longer than 10 minutes to complete. The survey includes questions about:

·       your professional background information such as your profession and type of practice

·       your practice of peri-procedural DOAC management for CVC insertion in PWC

·       your opinions on a clinical trial comparing continued to interrupted DOAC for CVC insertion in PWC

Your responses will be submitted anonymously through the survey, and no personal data will be collected.

There are no anticipated risks in participating in this study.

While there is no direct benefit to you, your input will help inform the design of an important clinical trial in cancer-related anticoagulation. 

Participants will not be named or identified in any study reports, publications, or presentations that may come from this study. Also, once the data is collected we will not be able to withdraw the data from the study.

You will not be paid for taking part in this study. 

Questions

If you have any questions, concerns or would like to speak to the study team for any reason, please contact Jameel Abdulrehman at Jameel.Abdulrehman@uhn.ca.

Please note that communication via e-mail is not absolutely secure. Thus, please do not communicate personal sensitive information via e-mail. 

If you have any questions about your rights as a research participant or have concerns about this study, call the Chair of the University Health Network Research Ethics Board (UHN REB) or the Research Ethics office number at 416-581-7849. The REB is a group of people who oversee the ethical conduct of research studies. The UHN REB is not part of the study team. Everything that you discuss will be kept confidential. 

By completing and submitting this online survey, you consent to participate in this study and your responses will be used solely for research purposes.

Thank you for your help with this endeavor.

Jameel Abdulrehman, MD, MSc, FRCPC, University of Toronto  

Joseph Shaw, MD, MSc, FRCPC, DRCPSC
University of Ottawa

Steffan Stella, MD, ScD, McMaster University

Sebastian Mafeld, MBBS, FRCR, University of Toronto

James Douketis, MD, FRCPC, McMaster University 

Rita Selby, MBBS, FRCPC, MSc, University of Toronto

Peter Gross, MD, MSc, FRCPC, University of Toronto                                           

Marc Carrier, MD, MSc, FRCPC, University of Ottawa

Dear colleagues,

Chimeric antigen receptor (CAR) T-cell therapy has significantly improved outcomes in patients with relapsed/refractory aggressive large B-cell lymphoma (R/R LBCL) and R/R multiple myeloma, and is rapidly being introduced to other disease fields. 

Thrombosis and bleeding complications are increasingly reported in patients undergoing CAR T-cell therapy, affecting an estimated 10–20% of patients. However, their incidence and risk factors remain unclear, also due to heterogeneity between reporting studies and missing data, causing these complications to remain under-recognized and poorly understood.

Current supportive care practices are largely extrapolated from stem cell transplant populations, despite CAR T-cell therapy’s distinct pathophysiology, and there is no consensus on optimal monitoring intervals, transfusion thresholds, or preventive interventions. 

Hence, to gain a better understanding of current practices in supportive care management for CAR T-cell patients, particularly in the hemostasis-related monitoring and supportive care, as well as how complications of thrombosis and bleeding in patients receiving CAR T-cell therapy are documented, we please ask you to complete the following survey: https://redcap.link/support_CART

Please feel free to distribute this survey among colleagues involved in CAR T-cell therapy, hemostasis and thrombosis, and/or transfusion medicine.

Thank you in advance for your contributions and collaboration.

On behalf of the ISTH SSC Cancer-associated thrombosis and hemostasis and EHA SWG on Transfusion,

Mandy Lauw, Darko Antic, Lizzie Jutchinson, Kirsty Sharplin, Simon Stanworth

Per the Guidelines and Guidance (G&G) Committee process for guidance manuscripts, draft manuscripts go through a public comment period and G&G Committee review and approval before submitting the manuscript to the Journal of Thrombosis and Haemostasis (JTH).

The G&G Committee would like to announce that the guidance manuscript titled, " Management of Thrombotic Risk Associated with Endocrine and Other Systemic Therapy in Patients with Breast Cancer: Guidance from the SSC of the ISTH," is now open for public comment. Note: This manuscript is confidential and in draft form.

Please click here to submit your comments by Thursday, February 19, 2026.