Cancer-Associated Venous Thromboembolic Disease, Version 1.2015

Abstract

The NCCN Guidelines for Cancer-Associated Venous Thromboembolic Disease outline strategies for treatment and prevention of venous thromboembolism (VTE) in adult patients with a diagnosis of cancer or for whom cancer is clinically suspected. VTE is a common complication in patients with cancer, which places them at greater risk for morbidity and mortality. Therefore, risk-appropriate prophylaxis is an essential component for the optimal care of inpatients and outpatients with cancer. Critical to meeting this goal is ensuring that patients get the most effective medication in the correct dose. Body weight has a significant impact on blood volume and drug clearance. Because obesity is a common health problem in industrialized societies, cancer care providers are increasingly likely to treat obese patients in their practice. Obesity is a risk factor common to VTE and many cancers, and may also impact the anticoagulant dose needed for safe and effective prophylaxis. These NCCN Guidelines Insights summarize the data supporting new dosing recommendations for VTE prophylaxis in obese patients with cancer.

Thrombosis in the setting of cancer

“…Therefore, at the present time, the author recommends that all hospitalized medical and surgical oncology patients receive thromboprophylaxis consistent with the National Comprehensive Cancer Network (NCCN) guidelines. 23 The American Society of Clinical Oncology (ASCO) guidelines recommend routine thromboprophylaxis in all hospitalized patients except for those admitted solely for a minor procedure or chemotherapy. 24 Future research initiatives should focus on demonstrating the efficacy of VTE prophylaxis in hospitalized medical oncology patients, and developing and validating cancerspecific VTE RAMs.…”

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

“…Additional key articles and other clinical practice guidelines 13,[15][16][17]132 on overlapping clinical questions were consulted and included. The search included meta-analyses, systematic reviews, randomised clinical trials, or non-randomised prospective or retrospective studies (in the absence of randomised clinical trials).…”

Managing thrombosis in cancer patients

“…(The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen), and found that overall, compared with VKA, LMWH reduced the risks of recurrent VTE by 40% (relative risk [RR] 0.60, 95% CI 0.45‐0.80) (Figure 1A) with no difference in major bleeding (RR 1.07, 95% CI 0.65‐1.75) (Figure 1B). Several major clinical guidelines have recommended LMWH as the first line therapy for treatment of acute CAT 34, 35, 36…”