Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy

Venous thromboembolism in women with ovarian cancer undergoing neoadjuvant chemotherapy prior to cytoreductive surgery: A retrospective study

“…Neither LMWH (relative risk 1.49, 95% CI 0.86-2.59) nor prophylactic dose direct oral anticoagulants (relative risk 1.95, 95% CI 0.88-4.30) are known to be associated with a significant increase in major bleeding. 17 In our view, both LMWH and anti-Xa inhibitors would be justified during NACT at prophylactic doses: both have a short half-life and their effects cease quickly after stopping in the presence of bleeding or before debulking surgery, after which they would be recommenced postoperatively, as is usual practice for LMWH.…”

“…Clear-cell disease and carcinosarcomas likely represent a higher risk and we would advocate for stronger consideration of thromboprophylaxis for these patients. 17 In our view, both LMWH and anti-Xa inhibitors would be justified during NACT at prophylactic doses: both have a short half-life and their effects cease quickly after stopping in the presence of bleeding or before debulking surgery, after which they would be recommenced postoperatively, as is usual practice for LMWH.…”

“…Several studies have looked at thromboprophylaxis in ambulatory cancer patients with a variety of solid tumors. A recent Cochrane review 17 found high-quality evidence that LMWH reduced the risk of any VTE compared with placebo by 43% (relative risk 0.57, 95% CI 0.46-0.71). Factor Xa inhibitors, a class of direct oral anti-coagulants, have been studied in two major relevant placebo-controlled trials: Apixaban in the AVERT trial, which contained 25.8% of patients with ovarian cancer, 18 and Rivaroxaban in the CASSINI trial, which contained a lower proportion of patients with ovarian cancer (6.4%).…”

“…19 Each of these trials demonstrated a significant reduction in the rates of VTE in the intention-to-treat population, and pooled analysis found that direct oral anti-coagulants significantly reduced the risk of VTE (5.2% on treatment vs. 9.3% on placebo (relative risk 0.55, 95% CI 0.34-0.90; p = 0.02). 17 However, in order to establish whether one or more of these agents should be offered to ovarian cancer patients during NACT, either routinely or as an ongoing trial, it is necessary to reliably estimate the incidence of VTE in these patients.…”

Validation of the Khorana score for predicting venous thromboembolism in 40 218 patients with cancer initiating chemotherapy

“…5 Primary prophylaxis with low-molecular-weight heparin reduces the risk of venous thromboembolism, but the associated bleeding risk and burden of daily injections have hampered its implementation into routine clinical practice. 6 Risk stratification tools have therefore been developed aiming to identify individuals at high risk of venous thromboembolism, among whom the risk-benefit ratio is favourable. 7 The most widely recommended is the Khorana score, originally designed to assess risk of venous thromboembolism in patients initiating chemotherapy.…”