Thromboembolism During Neoadjuvant Therapy for Gastrointestinal Cancer

Abstract

Thromboembolism a common, costly, and morbid complication that is also associated with decreased survival in cancer patients. The risk of thromboembolism in cancer patients is underappreciated. In addition to symptomatic deep venous thrombosis and pulmonary embolism, asymptomatic and arterial thromboembolic events are important consideration in ambulatory cancer patients receiving neoadjuvant chemoradiotherapy (nCRT). No specific randomized trial examining thromboprophylaxis (TP) during nCRT for gastrointestinal cancer has been performed, and none is accruing. Most guidelines currently recommend against TP in ambulatory cancer patients due to a lack of data rather than proof of harm or lack of efficacy. It is clear that robust data are urgently required, and that treatment with nCRT in patients with gastrointestinal malignancy is not an indication for routine pharmacological TP at the present time.

Predictive factors of thromboembolic complications in patients with esophagogatric adenocarcinoma undergoing preoperative chemotherapy

“…Importantly, there is no consensus on the potential use of thromboprophylaxis in patients undergoing neoadjuvant chemotherapy [21,22]. In the present cohort, Khorana score was not useful in predicting vTEEs, while Khanna et al [20] administered LMWH only in patients with a history of TEEs or thrombophilias and reported a relatively low incidence of vTEEs of 3% during neoadjuvant chemotherapy.…”

Impact of COVID-19 Pandemic on Surgical Breast Cancer Patients Undergoing Neoadjuvant Therapy: A Multicentric Study

“…On the one hand, many studies pointed towards the association between COVID-19 and ischemic and thrombotic disease, including following virus infection resolution (34)(35)(36)(37)(38). On the other hand, cases of vascular disease are reported in association with cancer drugs as well (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). Due to similar schedule of NACT and no cases of such adverse events in the Pre-COVID-19 group, we may postulate an association of vascular disease with COVID-19; however, due to small sample of cases we could not confirm this hypothesis.…”

Neoadjuvant chemoradiation for rectal cancer is not associated with higher rates of thromboembolism

“…Thromboembolic deterrent stockings and sequential compression devices were used routinely. Patients were not routinely screened for DVT as the study was observational, though it is known that asymptomatic DVT is important, as we have argued elsewhere . Patients did not receive postdischarge or extended thromboprophylaxis.…”