Management of venous thromboembolism in patients with lung cancer: a state-of-the-art review

Abstract

Venous thromboembolism (VTE) is common and life-threatening in patients with lung cancer. Management of VTE is critical for patients with lung cancer. Risk assessment, thromboprophylaxis and treatment of VTE constitute the core issues of VTE management in patients with lung cancer. Although its overall principles should follow recommendations in authoritative guidelines, VTE management in patients with lung cancer may be slightly special in some specific aspects. Despite the extensive validation of Khorana score for patients with all cancer types, its value in VTE risk assessment of patients with lung cancer is controversial. It is important to determine the VTE risk assessment score that can accurately and specifically assess the VTE risk of patients with lung cancer. Clinical practice patterns of thromboprophylaxis may vary by cancer types, since different sites of cancer may have different levels of VTE risk. To understand the thromboprophylaxis specific for lung cancer is of vital importance for patients with lung cancer. Although it is essential to comply with authoritative guidelines, the duration and timing of initiation of thromboprophylaxis in surgical patients with lung cancer may need further study. Taken together, the purpose of this review is to provide an overview of state-of-the-art VTE stewardship specific for patients with lung cancer.

Navigating venous thromboembolism risks in lung cancer patients

“…In contrast, they only recommend mechanical thromboprophylaxis for the risk with contraindications to the pharmacologic method. 3 We strongly recommend appropriate thromboprophylaxis when the "thrombosis threshold" is exceeded by the cumulative impact of acquired and genetic risk factors for symptomatic and asymptomatic patients. Maintaining a heightened awareness of each patient's risk, rather than rigidly adhering to local guidelines, is currently the most cost-effective and practical strategy to prevent lifethreatening VTE.…”

“…However, postoperative VTE is not uncommon in ordinary lung cancer patients undergoing surgery, with previous studies reporting incidence rates ranging from 4.5% to 13.9%. 3 Balancing the benefits of extended pharmacological thromboprophylaxis for these surgical patients with drawbacks like bleeding risks requires careful consideration of individual patient characteristics and preferences. Previous research has highlighted factors such as immobilization, being bedridden, having central venous catheters, experiencing sepsis, using sedative or anesthetic drugs, prolonged surgical duration, reliance on mechanical ventilation, elevated D‐dimer level, age exceeding 60 years, receiving more extensive surgical procedures than lobectomy, and reaching stage IV of lung cancer as contributors to the development of VTE in patients undergoing thoracic surgery for lung cancer.…”

“…Previous research has highlighted factors such as immobilization, being bedridden, having central venous catheters, experiencing sepsis, using sedative or anesthetic drugs, prolonged surgical duration, reliance on mechanical ventilation, elevated D‐dimer level, age exceeding 60 years, receiving more extensive surgical procedures than lobectomy, and reaching stage IV of lung cancer as contributors to the development of VTE in patients undergoing thoracic surgery for lung cancer. 3 Therefore, we also advocate for a nuanced risk assessment considering multiple predictors. This approach aims to strike a balance by appropriately addressing the needs of high‐risk patients while avoiding unnecessary pharmacological thromboprophylaxis for those at lower risk.…”

“…In contrast, they only recommend mechanical thromboprophylaxis for the risk with contraindications to the pharmacologic method. 3 …”