Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action

Abstract

PurposeVenous thromboembolism (VTE) is an increasingly frequent complication of cancer and its treatments, and is associated with worsened mortality and morbidity in patients with cancer.DesignThe Italian Association of Medical Oncology, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, the French National Federation of the League of Centers Against Cancer, and the European Society of Medical Oncology have recently published guidelines regarding VTE in patients with cancer. This review, authored by a working group of members from these panels, focuses on the methodology and areas of consensus and disagreement in the various clinical guidelines as well as directions for future research.ResultsThere is broad consensus regarding the importance of thromboprophylaxis in hospitalized patients with cancer, including prolonged prophylaxis in high-risk surgical patients. Prophylaxis is not currently recommended for ambulatory patients with cancer (with exceptions) or for central venous catheters. All of the panels agree that low molecular weight heparins are preferred for the long-term treatment of VTE in cancer. Areas that warrant further research include the benefit of prophylaxis in the ambulatory setting, the risk/benefit ratio of prophylaxis for hospitalized patients with cancer, an understanding of incidental VTE, and the impact of anticoagulation on survival.ConclusionWe call for a sustained research effort to investigate the clinical issues identified here to reduce the burden of VTE and its consequences in patients with cancer.

Spinal Epidural Hematoma during Anticoagulant Therapy for Pulmonary Embolism: Postoperative Complications in a Patient with Lung Cancer

“…This case met the definition of high risk because it was a major cancer surgery in a patient ≥40 years old, and recommended prophylaxis is IPC or anticoagulant therapy according to Japanese guidelines, whereas anticoagulant therapy is recommended by the ACCP and other societies including the American Society of Clinical Oncology and the European Society for Medical Oncology. 5,6) Anticoagulant therapy seemed necessary for preventing this patient from PE.…”

Thromboprophylaxis in Pancreatic Cancer: Why isn’t Prime Time Here Compared to Multiple Myeloma?

“…Despite these data, the only indication for VTE prophylaxis in Oncology (ESMO) is in MM patients when they are treated with immuno-modulators (iMiD) or with chemotherapy using high doses of steroids [11]. Only the International thrombosis society guidelines recommend the use of VTE prophylaxis in high risk ambulatory APC patients who are getting treatment with chemotherapy.…”

Thrombosis Associated with Immunomodulatory Agents in Multiple Myeloma

“…However, fixed-dose warfarin (1 mg/d) was ineffective in reducing the VTE rate [3,36]. Currently, outpatient VTE prophylaxis is recommended by the Italian Association of Medical Oncology, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, the French National Federation of the League of Centers Against Cancer and the European Society of Medical Oncology only for medical oncology patients receiving highly thrombogenic thalidomide-or lenalidomide-based combination chemotherapy regimens [80]. figure 1 below ).…”

“…Patients with MM being treated with IMiDs-based combinations should receive thromboprophylaxis [79][80]. There are data showing benefit of using low-molecular-weight heparin (LMWH), full-dose warfarin and daily aspirin in myeloma patients receiving IMiDs drugs [3,44,81].…”