2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

Farge, Dominique; Frère, Corinne; Connors, Jean M.; Khorana, Alok A.; Kakkar, Ajay K.; Ay, Cihan; Muñoz, Andrés; Brenner, Benjamin; Prata, Pedro Henrique; Brilhante, Dialina; Antić, Darko; Casais, Patricia; Guillermo, Cecilia; Ikezoe, Takayuki; Abutalib, Syed Ali; Meillón-Garcı́a, Luis Antonio; Bounameaux, Henri; Pabinger, Ingrid; Douketis, James D.; Ageno, Walter; Ajauro, Fernando; Alcindor, Thierry; Angchaisuksiri, Pantep; Arcelus, Juan I.; Barba, Raquel; Bazarbachii, Ali; Bellesœur, Audrey; Bensaoula, Okba; Benzidia, Ilham; Bita, Darius; Bitsadze, V. O.; Blickstein, Dorit; Blostein, Mark; Bogalho, Isabel; Brandão, António; Calado, Rodrigo T.; Carpentier, Antoine F.; Ceresetto, José; Chitsike, Rufaro S.; Connault, J.; Correia, Catarina Jacinto; Crichi, Benjamin; Paula, Erich Vinícius De; Demir, Ahmet Muzaffer; Deville, Laure; Doucet, Ludovic; Dounaevskaia, Vera; Durant, C.; Martin, Ellis; Emmerich, Joseph; Falanga, Anna; Font, Carme; Gallardo, Enrique; Tse, Gary; Gonçalves, Filipe; Gris, Jean‐Christophe; Hayashi, Hiromi; Hij, A.; Jara-Palomares, Luis; Jiménez, David; Khizroeva, J. Kh.; N'Guessan, Michel; Länger, Florian; Hello, C. Le; Maignan, Christine Le; Lecumberri, Ramón; Lee, Lai Heng; Liederman, Zachary; Santos, Luísa; Machado, Duarte Henrique; Makatsariya, Alexander; Maneyro, Alberto; Marjanovic, Zora; Milhaileanu, Serban; Monréal, Manuel; Morais, Sara; Moreira, A.; Mukai, Mikio; Ndour, Arlette; Oliveira, Luciana Correa Oliveira de; Otero-Candelara, Remedios; Pintão, Maria Carolina; Posch, Florian; Prilollet, Pascal; Rafii, Hanadi; Ribeiro, Daniel Dias; Riess, Hanno; Righini, Marc; Robert‐Ebadi, Helia; Rothschild, Cynthia B.; Roussin, André; Camino, José Antonio Rueda; Ruíz-Artacho, Pedro; Saharov, Gleb; Santos, Julia M.; Sebuhyan, Maxime; Shamseddine, Ali; Spectre, Galia; Taher, Alì; Trujillo‐Santos, Javier; Tzoran, Inna; Villiers, S.; Wong, Raymond; Yamashita, Yugo; Yannoutsos, Alexandra; Yasuda, Chikao

doi:10.1016/s1470-2045(22)00160-7

Cited by 201 publications

(136 citation statements)

References 94 publications

(210 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…No difference of major bleeding was observed in the CARAVAGGIO Study between the apixaban and the dalteparin groups (HR = 0.82; 95% CI: 0.40–1.69), also in patients with gastrointestinal cancer [ 21 , 22 ]. The guidelines took those observations differently into account [ 8 , 9 , 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…There remain unaddressed needs in the daily management of patients with CAT; this is the case of patients with thrombocytopenia occurrence or patients who undergo VTE recurrence during anticoagulant treatment. The guidelines propose algorithms with a low level of recommendation for managing those situations due to the paucity of data [ 8 , 9 , 10 , 11 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…The risk of major bleeding on DOAC as compared to dalteparin is different according to the study (HR = 1.74; 95% CI: 0.95–3.18) [ 5 ] and in the SELECT D Study (HR = 1.83; 95% CI: 0.68–4.96) [ 6 ] but not in the CARAVAGGIO study (HR = 0.82; 95% CI: 0.40–1.69) [ 7 ], and overall, the risk of clinically relevant bleedings (sum of major bleeding and clinically relevant non-major bleedings) was increased in DOACs as compared to LMWHs (HR = 1.47; 95% CI: 1.17–1.84) [ 4 ]. DOACs have therefore been proposed as a treatment option by many guidelines for the initial treatment of patients with CAT for up to 6 months [ 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management of Cancer-Associated Thrombosis in France: A National Survey among Vascular Disease and Supportive Care Specialists

Mahé

Chapelle

Plaisance

et al. 2022

Cancers

View full text Add to dashboard Cite

Low molecular weight heparins (LMWHs) are recommended by international guidelines for at least 6 months in patients with cancer-associated thromboembolism (CAT). Direct oral anticoagulants (DOACs) have been proposed as an alternative to LMWH. In clinical practice, the specialists in charge of CAT have to decide which anticoagulant to prescribe. An electronic survey tool, including vignettes and questions, was sent to members of the French Society of Vascular Medicine, the French-speaking association for supportive care in oncology and the Investigation Network On Venous Thrombo-Embolism. Among the 376 respondents, LMWHs were reported as the first choice by most specialists. The prescription of DOACs within the first 3 weeks of CAT diagnosis was highly dependent on the cancer site: 5.9%, 18.6% and 24.5% in patients with locally advanced colorectal, lung and breast cancer, respectively. The determinants were mostly related to cancer (site and stage or evolution) and to anticancer treatments. For 61% of physicians, some anticancer treatments were contraindications to DOACs. However, almost 90% of physicians considered switching to DOAC after a median 3-month period of LMWHs. In daily practice, LMWHs and DOACs are now considered by specialists of CAT; the decision is mostly driven by the site of cancer. The role of anticancer treatments in the decision remains to be investigated.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Cancer-Associated Thrombosis in France: A National Survey among Vascular Disease and Supportive Care Specialists

Mahé

Chapelle

Plaisance

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“… DOACs or LMWH suggested for the long-term treatment (>6 months). ITAC 2022 , 87 DOACs (apixaban or rivaroxaban started immediately, edoxaban started after parenteral anticoagulation) can be used, as an alternative to LMWH, for the initial treatment of CAT (first 10 days) in patients without high risk of gastrointestinal or genitourinary bleeding. DOACs (apixaban, edoxaban, rivaroxaban) or LMWH suggested for the early (up to 6 months) and long-term (>6 months) treatment of CAT.…”

Section: Current Guidelines On the Prevention And Treatment Of Cancer...mentioning

confidence: 99%

Direct Oral Anticoagulants for the Prevention and Acute Treatment of Cancer-Associated Thrombosis

Attard¹,

Gatt²,

Bertoletti³

et al. 2022

VHRM

View full text Add to dashboard Cite

Cancer is a major risk factor for venous thromboembolism (VTE), and cancer-associated thrombosis (CAT) constitutes approximately 15–25% of all VTE cases. For decades, the standard treatment for CAT used to be daily subcutaneous low molecular weight heparin (LMWH). Data on the safety and efficacy of the direct oral anticoagulants (DOACs) in this population emerged only in recent years and specific DOACs were included into recent guidelines recommendations. In this narrative review of the literature, we reported the results of the phase III randomized controlled trials that evaluated the DOACs for the prevention and the acute treatment of CAT. For the acute phase treatment, the anti-Xa inhibitors (apixaban, edoxaban, rivaroxaban) showed better efficacy than LMWH in preventing VTE recurrence; however, rivaroxaban and edoxaban were also associated with an increased risk of bleeding events. For primary prevention of CAT in ambulatory cancer patients starting chemotherapy, apixaban and rivaroxaban showed better efficacy than placebo but a trend towards higher bleeding rates. Recent guidelines suggest the DOACs for the treatment of CAT in selected cancer patients (eg, low bleeding risk, no luminal gastrointestinal or genitourinary malignancies, no interfering medications). The DOACs are also suggested for primary thromboprophylaxis in selected ambulatory cancer patients at high risk of VTE (eg, Khorana score ≥2 prior to starting new chemotherapy, low bleeding risk, no interfering medications).

show abstract

“…Patients with cancer are at increased risk of venous thromboembolism (VTE), and VTE appearing in patients with cancer implies an increased risk of VTE recurrences, bleeding, and mortality [ 1 , 2 , 3 , 4 ]. Current guidelines on antithrombotic therapy, based on the results of randomized clinical trials, provide recommendations that apply to patients with all types of cancers [ 5 , 6 , 7 ]. However, cancer is a widely heterogeneous disease, and the risk of recurrences, bleeding, or death may differ according to the cancer site or other variables [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Cancer Histology and Natural History of Patients with Lung Cancer and Venous Thromboembolism

Ruiz-Artacho

Trujillo‐Santos

Font

et al. 2022

Cancers

Self Cite

View full text Add to dashboard Cite

Background: In patients with lung cancer and venous thromboembolism (VTE), the influence of cancer histology on outcome has not been consistently evaluated. Methods: We used the RIETE registry (Registro Informatizado Enfermedad TromboEmbólica) to compare the clinical characteristics and outcomes during anticoagulation in patients with lung cancer and VTE, according to the histology of lung cancer. Results: As of April 2022, there were 482 patients with lung cancer and VTE: adenocarcinoma 293 (61%), squamous 98 (20%), small-cell 44 (9.1%), other 47 (9.8%). The index VTE was diagnosed later in patients with squamous cancer than in those with adenocarcinoma (median, 5 vs. 2 months). In 50% of patients with adenocarcinoma, the VTE appeared within the first 90 days since cancer diagnosis. During anticoagulation (median 106 days, IQR: 45–214), 14 patients developed VTE recurrences, 15 suffered major bleeding, and 218 died: fatal pulmonary embolism 10, fatal bleeding 2. The rate of VTE recurrences was higher than the rate of major bleeding in patients with adenocarcinoma (11 vs. 6 events), and lower in those with other cancer types (3 vs. 9 events). On multivariable analysis, patients with adenocarcinoma had a non-significantly higher risk for VTE recurrences (hazard ratio [HR]: 3.79; 95%CI: 0.76–18.8), a lower risk of major bleeding (HR: 0.29; 95%CI: 0.09–0.95), and a similar risk of mortality (HR: 1.02; 95%CI: 0.76–1.36) than patients with other types of lung cancer. Conclusions: In patients with lung adenocarcinoma, the rate of VTE recurrences outweighed the rate of major bleeding. In patients with other lung cancers, it was the opposite.

show abstract

2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

Cited by 201 publications

References 94 publications

Management of Cancer-Associated Thrombosis in France: A National Survey among Vascular Disease and Supportive Care Specialists

Management of Cancer-Associated Thrombosis in France: A National Survey among Vascular Disease and Supportive Care Specialists

Direct Oral Anticoagulants for the Prevention and Acute Treatment of Cancer-Associated Thrombosis

Cancer Histology and Natural History of Patients with Lung Cancer and Venous Thromboembolism

Contact Info

Product

Resources

About