Do we need prophylactic anticoagulation in ambulatory patients with lung cancer? A review

Abstract

Venous thromboembolism is a common complication of malignancy. Lung cancer is considered one of the most thrombogenic cancer types. Primary thromboprophylaxis is not currently recommended for all ambulatory patients with active cancer. In the present narrative review we aim to summarize recent data on the safety and efficacy of primary thromboprophylaxis as well as on venous thromboembolism risk assessment, focusing on ambulatory patients with lung cancer. A potential benefit from prophylactic anticoagulation with low molecular weight heparins in terms of venous thromboembolism risk reduction and increased overall survival in patients with lung cancer, without a significant increase in bleeding risk, has been reported in several studies. Recent studies also reveal promising results of direct oral anticoagulants regarding their efficacy as primary thromboprophylaxis in patients with cancer, including those with lung cancer. However, the use of different study methodologies and the heterogeneity of study populations among the trials limit the extraction of definite results. More randomized, controlled trials, restricted to a well-characterized population of patients with lung cancer, are greatly anticipated. The use of risk assessment tools for stratification of venous thromboembolic risk is warranted. The development of an accurate and practical risk assessment model for patients with lung cancer represents an unmet need.

Thromboembolic Disease in Patients With Cancer and COVID-19: Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations–State-of-the-Art

“…The Khorana score is the most well-known and can be easily applied to patients with active cancer before the initiation of anticancer treatment (81). However, it has a low accuracy in the evaluation of the risk for VTE particularly in patients with cancer associated with moderate or low risk (i.e., lung cancer, breast cancer, prostate cancer, gynecological and colon cancer as well as in lymphoma) and it is not applicable after anticancer treatment initiation (82). The COMPASS-CAT score has been independently validated and is accurate for the prediction of VTE in patients with breast, lung colon or ovarian cancer (83).…”

“…The COMPASS-CAT score has been independently validated and is accurate for the prediction of VTE in patients with breast, lung colon or ovarian cancer (83). Other scoring systems, such as VIENNA CATS, PROTECT, and CONKO have been proposed for the evaluation of the risk of CAT in ambulatory patients receiving anticancer therapy (82)(83)(84)(85)(86)(87).…”

Risk Factors for Venous Thromboembolism in Patients With Small Cell Lung Cancer

“…The annual incidence of venous thromboembolism (VTE) ranges from 1 to 2 per 1,000 individuals per year in the general population (4,5). Malignancy constitutes a significant risk factor for VTE, with cancer patients facing 4 to 10 times higher risk of developing VTE compared with the general population; risk of developing VTE is 20 times higher in patients with lung cancer in particular (6)(7)(8)(9)(10)(11). The incidence of VTE in SCLC patients ranges between 6.8% and 11.5% (12,13).…”

Vascular medicine and cardio-oncology – A new, evolving clinical frontier

“…These concepts are illustrated by case reports and vascular images by Banathy et al, Shah and Silver, and Wilkins et al [10][11][12] Cancer therapies can also lead to increased coagulability or damage to the endothelium, further illustrating the multifaceted interaction between cancer, cancer treatment, and CVD. Therefore, indication, timing, and dosing of prophylactic anticoagulation in patients with cancer is an ongoing debate nicely summarized by an editorial by Khorana, 13 as well as a review article by Gomatou et al, 14 the latter discussing the use of prophylactic anticoagulation in the ambulatory setting in patients with lung cancer. The main reason for restraint is an increase in bleeding risk due to close relation or ingrowth of the tumor to blood vessels, a particular challenge in patients with gastric cancer and summarized by Majmudar et al 15 Another exciting and emerging frontier in cardio-oncology is the growing appreciation that common risk factors contribute to co-occurrence of CVD and cancer.…”