Clinical practice guidelines for prophylaxis of venous thomboembolism in cancer patients

Abstract

Symptomatic venous thromboembolism (VTE) occurs 4-7 times more frequently in cancer patients as compared to non-cancer patients. A significant number of risk factors, which can be subcategorised as patient-, cancer- or treatment-related, have been shown to influence the risk of VTE during malignancy and further incorporated in risk-assessment models. Safe and efficient thromboprophylaxis regimens allow substantial decreased in VTE rates, since VTE is most often a largely preventable disease, but thromboprophylaxis remains underused in cancer compared to non-cancer patients. If thromboprophylaxis is warranted in cancer patients undergoing surgery or hospitalised for acute medical illness or with a lower mobility in the absence of contraindications to anticoagulants, its benefit remains controversial in outpatients and may be limited to locally advanced or metastatic pancreatic or lung cancer treated with chemotherapy. The International Initiative on Thrombosis and Cancer-CME free mobile app (ios and android), based on the International Clinical Practice Guidelines (CPG), facilitates their implementation and dissemination of knowledge worldwide so as to improve VTE treatment and prophylaxis in cancer patients.

Cancer-associated thrombosis in patients with implanted ports: a prospective multicenter French cohort study (ONCOCIP)

“…In addition, whereas prophylaxis with anticoagulants did not show benefit in preventing catheter-related thrombosis, 19,20 our results suggest that antiplatelet therapy may be of value. On the other hand, the occurrence of venous thromboembolism unrelated to the catheter is influenced by various factors [8][9][10] and is associated with significantly increased morbidity and mortality in patients with cancer. [1][2][3][4][5][6] Venous thromboembolism prevention may therefore rely on anticoagulant drugs to improve patient prognosis.…”

“…7 Besides cancer-related variables (eg, site and stage) and patient-related factors, specific conditions associated with cancer such as stasis because of immobilization, surgery, infections, and use of prothrombotic chemotherapeutic agents may contribute to this hypercoagulable state. [8][9][10] Long-term central venous catheters, including those involving port implantation, are increasingly used with the expansion of the population of cancer patients who require chemotherapy and intravenous administration of supportive care treatments, but their placement may be complicated by thrombotic events, in particular upper extremity deepvein thrombosis owing to direct vascular damage. [11][12][13] Specific antineoplastic agents infused through implanted ports may additionally influence the risk of catheter-related thrombosis.…”

Pulmonary Hypertension: Definition, Classification, and Diagnosis

“…8 Later, in 1998, in Evian, France, a new structure of classification was proposed, which still forms the basis of the current classification. 9 This classification follows a better approach to define the homogenous groups sharing similarities in terms of predominant pathophysiological mechanisms involved, clinical characteristics, and management. This intrinsic characteristic of the current classification also allowed conducting of clinical trials with consequent approval of targeted therapies in pulmonary arterial hypertension (PAH).…”

Aspirin Is Associated With Reduced Rates of Venous Thromboembolism in Older Patients With Cancer

“…Moreover, no guidelines have focused on aspirin use in elderly patients with cancer. 24,25 In the present study, we examined whether aspirin was associated with lower rates of VTE and mortality in older patients with cancer. We used data from the latest available National Inpatient Sample (NIS), which is the largest inpatient discharge database in the United States and stores data on more than 210 000 cancer patients who are !65 years old.…”