Prevention and treatment of venous thromboembolism in patients with cancer

Abstract

Venous thromboembolism (VTE) is the second leading cause of death and a major cause of morbidity in patients with cancer. Pharmacologic thromboprophylaxis is recommended in all hospitalized cancer patients without contraindications to anticoagulants. The role of thromboprophylaxis in outpatients undergoing chemotherapy is less certain because of the diversity of the tumor types and their associated risks of VTE and bleeding. Thromboprophylaxis should only be considered in patients at high risk for VTE. Cancer patients with a newly diagnosed VTE should be preferably treated with low-molecular-weight heparin for a minimum of 3-6 months. Treatment duration should be individualized based on the clinical status and stage of the cancer, the risk of recurrent VTE, the risk of bleeding, and personal preference of the patient. Further research is required to assess the role of the new oral anticoagulants (direct Xa and thrombin inhibitors) for this high-risk population.

Non–Vitamin K Antagonist Oral Anticoagulants and Factors Influencing the Ischemic and Bleeding Risk in Elderly Patients With Atrial Fibrillation: A Review of Current Evidence

“…97 VTE is the second most frequent cause of death in people with cancer, and it is recommended that all cancer patients admitted to hospital should be evaluated to receive anticoagulant therapy. 98 Patients with advanced cancer in hospice care are at high risk of VTE, usually because of older age, advanced or metastatic disease, and decreased mobility. The use of NOACs is beneficial in this setting, where the goal is promoting quality of life rather than lengthening survival, because treatment may reduce unpleasant symptoms of thromboembolism, such as pain, edema, and dyspnea.…”

Non-atherosclerotic aortic mural thrombus: a rare source of embolism

“…Particularly, venous thromboembolism is six times more likely to develop in patients with an active malignancy than patients without it 15. Because of its frequency, guidelines advocate for the use of thromboprophylaxis with either unfractionated heparin or low-molecular-weight heparin for hospitalised patients with cancer 16. Prophylaxis is not routinely recommended for outpatients undergoing chemotherapy; however, some authors promote its use when a low risk of bleeding is present in the clinical settings of locally advanced or metastatic pancreatic (grade 1B) or lung cancer (grade 2B) 17…”

Development of a chemiluminescence assay for tissue plasminogen activator inhibitor complex and its applicability to gastric cancer

“…This treatment has been known to improve the survival rate of tumor patients. However, VTE remains the second leading cause of death in patients with malignant tumors [ 13 ]. Therefore, early diagnosis and prediction of venous thrombosis in cancer patients is of utmost importance for preventative measures in clinical settings.…”