2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

Farge, Dominique; Frère, Corinne; Connors, Jean M.; Ay, Cihan; Khorana, Alok A.; Muñoz, Andrés; Brenner, Benjamin; Kakkar, Ajay K.; Rafii, Hanadi; Solymoss, Susan; Brilhante, Dialina; Monréal, Manuel; Bounameaux, Henri; Pabinger, Ingrid; Douketis, James D.; Ageno, Walter; Ajauro, Fernando; Al-Aboudi, Kamal R.; Alcindor, Thierry; Thewis, André; Angchaisuksiri, Pantep; Antić, Darko; Arcelus, Juan I.; Assenat, Éric; Bauer, Kenneth A.; Bazarbachii, Ali; Benzidia, Ilham; Beyer‐Westendorf, Jan; Bitsadze, V. O.; Blickstein, Dorit; Blostein, Mark; Bogalho, Isabel; Bournet, Barbara; Casais, Patricia; Carpentier, Antoine F.; Cesarman‐Maus, Gabriela; Chakbrabartty, Joydeep; Clemente, Hugo; Connault, J.; Doucet, Ludovic; Durant, C.; Emmerich, Joseph; Falanga, Anna; Feistritzer, Clemens; Font, Carme; Francis, Charles W.; Gallardo, Enrique; Tse, Gary; Gris, Jean‐Christophe; Guillermo, Cecilia; Hij, A.; Hull, Russel; Ikezoe, Takayuki; Jara‐Palomares, Luis; Key, Nigel S.; Khrizroeva, Jamilya; Koolian, Maral; Länger, Florian; Hello, C. Le; Lecumberri, Ramón; Lee, Lai Heng; Liebman, Howard A.; Santos, Luísa; Machado, Duarte Henrique; Madelaine, Isabelle; Makatsariya, Alexander; Mandalà, Mario; Marayevas, Anthony; Marjanovic, Zora; Marosi, Christine; Martin, Ellis; Meillón, Luis; Messas, Emmanuel; Moreira, A.; Demir, Ahmet Muzaffer; Ndour, Arlette; N'Guessan, Michel; Otero, Remedios; Olmos, Vanessa Pachón; Pais, Ana; Posch, Florian; Preusser, Matthias; Riess, Hanno; Righini, Marc; Rothschild, Cynthia B.; Roussin, André; Rueda-Camino, José Antonio; Ruiz-Artacho, Pedro; Saseedharan, Sanjith; Shamseddine, Ali; Soff, Gerald A.; Stricker, Hans; Tagalakis, Vicky; Taher, Alì; Toutou, T.; Trujillo‐Santos, Javier; Villiers, S.; Wong, Raymond; Yamada, Norizaku

doi:10.1016/s1470-2045(19)30336-5

Cited by 522 publications

(637 citation statements)

References 85 publications

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“…Evidence supporting the use of direct oral anticoagulants (DOAC) have recently become available with the publication of two dedicated noninferiority trials and one large pilot study [14][15][16] demonstrating that DOAC are non-inferior to LMWH for the prevention of recurrent VTE in this specific population, but confer a higher risk of bleeding in patients with gastrointestinal and genitourinary malignancies, which provided a significant advance in the field [17,18]. In light of these results, both DOAC and LMWH are now recommended as first-line option for the treatment of CAT by all recent guidelines [19][20][21].…”

Section: Recent Surgery Hospitalization Central Venous Cathetersmentioning

confidence: 99%

Are Patients with Active Cancer and Those with History of Cancer Carrying the Same Risks of Recurrent VTE and Bleeding While on Anticoagulants?

Frère

Crichi

Lejeune

et al. 2020

Cancers

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Direct oral anticoagulants (DOAC) are now recommended for the treatment of cancer-associated thrombosis (CAT) based on the results of dedicated trials demonstrating that DOAC are non-inferior to low molecular weight heparins in preventing recurrent venous thromboembolism (VTE) in this population. The definition of "cancer patient" differs substantially among studies. Whether patients with active cancer and those with a history of cancer (HOC) carry the same risks of recurrent VTE and bleeding remains unclear. Few studies reported data on the efficacy and safety of anticoagulants according to active cancer or HOC categories. While in subgroup analyses of EINSTEIN and HOKUSAI the rates of recurrent VTE and bleeding did not differ between these categories, results from a subgroup analysis of AMPLIFY, from HOKUSAI-Cancer, and from the COMMAND cohort suggest that HOC patients might have a lower bleeding risk than active cancer patients. Whether the inclusion of HOC patients in CAT studies might introduce some bias by decreasing the rates of both recurrent VTE and bleeding remains an unanswered issue since no dedicated prospective study addressed this question. A strict definition of active cancer should be used in further trials.

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Section: Recent Surgery Hospitalization Central Venous Cathetersmentioning

confidence: 99%

Are Patients with Active Cancer and Those with History of Cancer Carrying the Same Risks of Recurrent VTE and Bleeding While on Anticoagulants?

Frère

Crichi

Lejeune

et al. 2020

Cancers

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“…CAT management benefits from the availability of parenteral anticoagulants, particularly for patients experiencing nausea and vomiting or impaired gastrointestinal absorption. Long‐standing experience with LMWH use, and the flexible LMWH dose adjustments, allows for easier or more flexible management of thrombocytopenia and invasive interventions than with other anticoagulants, for example, VKAs . Challenges with parenteral administration (eg, inconvenience and discomfort of daily injections), alongside the high cost of LMWHs, may be burdensome for patients needing long‐term anticoagulation therapy; CAT treatment guidelines support anticoagulation therapy for at least 3 to 6 months for the prevention of recurrent VTE …”

Section: Rationale For Studying the Use Of Doacs For Catmentioning

confidence: 99%

“…In addition, the durations of therapy in these studies were relatively short (~3‐4 months), limiting the ability to adequately assess the value of prophylactic anticoagulation . Consequently, guidelines do not recommend routine thromboprophylaxis for ambulatory patients with cancer …”

Section: Current Controversies In Catmentioning

confidence: 99%

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Cancer‐associated venous thromboembolism: Treatment and prevention with rivaroxaban

Bauersachs¹,

Khorana

Lee

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Cancer‐associated venous thromboembolism (VTE) is a frequent, potentially life‐threatening event that complicates cancer management. Anticoagulants are the cornerstone of therapy for the treatment and prevention of cancer‐associated thrombosis (CAT); factor Xa–inhibiting direct oral anticoagulants (DOACs; apixaban, edoxaban, and rivaroxaban), which have long been recommended for the treatment of VTE in patients without cancer, have been investigated in this setting. The first randomized comparisons of DOACs against low‐molecular‐weight heparin for the treatment of CAT indicated that DOACs are efficacious in this setting, with findings reflected in recent updates to published guidance on CAT treatment. However, the higher risk of bleeding events (particularly in the gastrointestinal tract) with DOACs highlights the need for appropriate patient selection. Further insights will be gained from additional studies that are ongoing or awaiting publication. The efficacy and safety of DOAC thromboprophylaxis in ambulatory patients with cancer at a high risk of VTE have also been assessed in placebo‐controlled randomized controlled trials of apixaban and rivaroxaban. Both studies showed efficacy benefits with DOACs, but both studies also showed a nonsignificant increase in major bleeding events while on treatment. This review summarizes the evidence base for rivaroxaban use in CAT, the patient profile potentially most suited to DOAC use, and ongoing controversies under investigation. We also describe ongoing studies from the CALLISTO (Cancer Associated thrombosis—expLoring soLutions for patients through Treatment and Prevention with RivarOxaban) program, which comprises several randomized clinical trials and real‐world evidence studies, including investigator‐initiated research.

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“…5 In this regard, the authors, though well intentioned, veer into territory beyond the purview of guidance and, in doing so, may be undermining the value of their work, especially as other medical societies have recently published CPGs addressing the prevention and treatment of VTE in cancer patients. 6,7 Developing a CPG involves a structured; methodologically rigorous; and, often, arduous process. infrastructure to develop bona fide CPGs on a broad range of topics in thrombosis and hemostasis, some of which are beyond the interest of other medical societies.…”

mentioning

confidence: 99%

Prevention of venous thromboembolism in medical cancer patients: Guidance or guideline?

Douketis

2020

Journal of Thrombosis and Haemostasis

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2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

Cited by 522 publications

References 85 publications

Are Patients with Active Cancer and Those with History of Cancer Carrying the Same Risks of Recurrent VTE and Bleeding While on Anticoagulants?

Are Patients with Active Cancer and Those with History of Cancer Carrying the Same Risks of Recurrent VTE and Bleeding While on Anticoagulants?

Cancer‐associated venous thromboembolism: Treatment and prevention with rivaroxaban

Prevention of venous thromboembolism in medical cancer patients: Guidance or guideline?

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