Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline

Falanga, Anna; Ay, Cihan; Nisio, Marcello Di; Gerotziafas, G.; Länger, Florian; Lecumberri, Ramón; Mandalà, Mario; Maraveyas, Anthony; Pabinger, Ingrid; Jara-Palomares, Luis; Sinn, Marianne; Syrigos, Kostas; Young, Annie; Jordan, Karin

doi:10.1016/j.annonc.2022.12.014

Cited by 111 publications

(145 citation statements)

References 92 publications

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“…Based on these findings, recent guidelines mostly suggest that either apixaban, edoxaban, rivaroxaban, or LMWH can be used for the management of CAT (Table ). [58][59][60][61][62][63] Anticoagulation should be tailored based on patient characteristics and preferences and should be adapted and reassessed on a regular basis, as the patient's cancer status and management change over time (Figure 2). 64…”

Section: Management Of Catmentioning

confidence: 99%

Updates in the Incidence, Pathogenesis, and Management of Cancer and Venous Thromboembolism

Girardi

Wang

Ageno

et al. 2023

ATVB

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Patients with cancer are at higher risk of developing venous thromboembolism (VTE) compared with the general population. This elevated risk is due to several risk factors and multiple, overlapping thrombotic and hemostatic pathophysiological pathways that are specific to this patient population. Hence, the management of cancer-associated VTE can be challenging for clinicians. Patients with cancer-associated VTE are at higher risk of both recurrent events despite anticoagulation and bleeding complications due to the anticoagulant regimens. Direct oral anticoagulants have recently been shown to be effective, safe, and more convenient than parenteral low-molecular-weight heparin for the management of cancer-associated VTE. Despite these recent advances in anticoagulant therapy, many unmet needs remain in these patients (increased risk of bleeding with specific cancer types, drug-to-drug interactions, liver dysfunction). Factor XI inhibitors are currently being assessed for the management of cancer-associated VTE and may help clinicians address these important knowledge gaps.

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Section: Management Of Catmentioning

confidence: 99%

Updates in the Incidence, Pathogenesis, and Management of Cancer and Venous Thromboembolism

Girardi

Wang

Ageno

et al. 2023

ATVB

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“…Despite the need for daily subcutaneous injections and their relatively higher cost, the guidelines recommend LMWHs over VKAs 16,17 . Patients generally prefer to use drugs that are taken orally and do not require biological monitoring 18,19 .…”

Section: Warfarin and Lmwhmentioning

confidence: 99%

Cancer‐associated thrombosis and drug–drug interactions of antithrombotic and antineoplastic agents

Bölek

Ürün

2023

Cancer

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Venous thromboembolism (VTE) is often associated with malignant diseases and notably contributes to morbidity and mortality in patients with cancer. Cancer‐associated thrombosis (CAT) brings additional costs to health expenditures and has a negative impact on oncological outcomes. Either the recurrence rate of VTE or bleeding complications are also higher in patients with cancer. Prophylactic anticoagulation has been recommended in peri‐surgical periods, inpatient settings, and high‐risk ambulatory patients. Although various risk stratification scores are used, none are ideal for identifying patients who can benefit from anticoagulant prophylaxis. New risk scoring systems or biomarkers are needed to identify patients who are more likely to benefit from prophylaxis with low bleeding risk. The questions about the patients who will be given prophylaxis and those who develop thromboembolism, with which drug, and how long they will be treated are still not fully answered. Anticoagulation is the cornerstone of the treatment, but management of CAT remains complex. Low molecular weight heparins and direct oral anticoagulants are effective and safe options for the treatment of CAT. Recognizing adverse effects, drug–drug interactions, and accompanying conditions that cause dose adjustment is crucial. Prevention and treatment of VTE in patients with cancer require a multidisciplinary and patient‐based approach.Plain Language Summary Cancer‐associated thrombosis is a significant cause of mortality and morbidity in patients with cancer. Chemotherapy, surgery, and/or use of central venous access remarkably increase the risk of thrombosis. Prophylactic anticoagulation should be considered not only in inpatient follow‐up and during peri‐surgical period but also ambulatory patients with a high risk of thrombosis. Many parameters, such as drug–drug interactions, primary side of cancer, and comorbidities of patients should be considered when selecting anticoagulant drugs. More accurate risk stratification scores or biomarkers are still an unmet need.

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“…Trotz einiger Limitationen, wurde der Khorana-Score in zwei prospektiven Studien validiert und ergab ein VTE-Risiko von 9-10% in 6 Monaten bei einem Khorana-Score ≥2 [14]. Patienten mit Blasenkarzinom und Hodentumor haben dementsprechend mindestens ein intermediäres Risiko (1 Punkt).…”

Section: Risikoscore Zur Thromboseabschätzungunclassified

“…Somit wurde zusammenfassend die Rate an VTE um 30-60% reduziert und Blutungsrate verdoppelt. Dementsprechend werden im Hinblick auf einzusetzenden Substanzen zur Prophylaxe thromboembolischer Komplikationen sowohl NMH als auch der Einsatz von DOAKs wie Apixaban und Rivaroxaban gleichermaßen empfohlen [14,31]. In der AVERT und CASSINI-Studie waren jedoch nur wenige Patienten mit urogenitalen Tumoren inkludiert (AVERT: 1,6% mit urogenitalen Tumoren, CASSINI: 3,8% mit urogenitalen Tumoren, kein Prostatakarzinom), sodass unklar bleibt, ob diese Ergebnisse auch auf urogenitale Tumore übertragbar sind [29,30].…”

Section: Arten Der Prophylaxeunclassified

Thrombembolie-Risikofaktoren und Prophylaxe

Paffenholz

2023

Aktuelle Urol

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Zusammenfassung Venöse Thromboembolien stellen eine wichtige Komplikation bei Tumorpatienten, da sie bei diesen Patienten gehäuft auftreten und eine relevante Morbidität bedingen. Das Risiko für thromboembolische Komplikationen bei Tumorpatienten liegt 3–9-mal höher als bei Nichttumorpatienten und stellt die zweithäufigste Todesursache bei Tumorpatienten dar. Das Thromboserisiko hängt neben der tumorinduzierten Koagulopathie von individuellen Faktoren, der Art und dem Stadium der Krebserkrankung, der Zeit seit der Krebsdiagnose sowie der Art einer systemischen Krebstherapie ab. Eine Thromboseprophylaxe bei Tumorpatienten ist wirksam, kann jedoch mit erhöhten Blutungen einhergehen. Auch wenn dezidierte Empfehlungen für einzelne Tumorentitäten aktuell nicht vorliegen, empfehlen internationale Leitlinien prophylaktische Maßnahmen bei Hochrisikopatienten. So kann ein Thromboserisiko von >8–10% als Indikation für eine Thromboseprophylaxe angesehen werden. Dieses Risiko wurde bei Patienten mit einem Khorana-Score von ≥2 erreicht und sollte individuell mithilfe der Nomogramme berechnet werden. Vor allem bei Patienten mit geringem Blutungsrisiko wird diese Empfehlung ausgesprochen. Während des Arztgesprächs sollten zudem Risikofaktoren und Symptome eines thromboembolischen Events thematisiert und Materialien zur Patientenaufklärung ausgehändigt werden.

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Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline

Cited by 111 publications

References 92 publications

Updates in the Incidence, Pathogenesis, and Management of Cancer and Venous Thromboembolism

Updates in the Incidence, Pathogenesis, and Management of Cancer and Venous Thromboembolism

Cancer‐associated thrombosis and drug–drug interactions of antithrombotic and antineoplastic agents

Thrombembolie-Risikofaktoren und Prophylaxe

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