Safety and efficacy of primary thromboprophylaxis in cancer patients

Abstract

Cancer is often complicated by venous thromboembolism (VTE), a common and potentially fatal complication associated with poor prognosis in these patients. An increased incidence of VTE is being observed due to the advanced age of cancer patients, the thrombogenic effect of novel drugs and advances in the diagnosis of related complications. In this review, we look at five different risk groups of cancer patients with an increased probability of developing VTE, including hospitalized patients undergoing chemotherapy, patients undergoing a surgical procedure, ambulatory patients undergoing chemotherapy, patients with a central venous access and patients receiving antiangiogenic drugs or anticoagulant therapy due to previous chronic diseases. The aim of this review is to summarize the most important clinical evidence reported to date on the suitability of primary thromboprophylaxis to cancer patients. Recommendations have drawn up for each group based on current evidence and guidelines to facilitate decision-making in clinical practice.

SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018)

“…In patients with solid tumors, FN has an identifiable clinical focus in 65% of the episodes; however, microbiological documentation is only possible in 20–30% of the cases and blood cultures are positive in 10–25% [ 14 , 15 ]. Etiology is usually bacterial, due to both Gram-negative bacilli, as well as Gram-positive cocci (approximate ratio of 3:2).…”

“…In these unstable patients, mortality due to sepsis is 18.1% versus 2.7% of patients without risk factors [ 29 ]. Infections entailing greater mortality are chronic obstructive pulmonary disease (COPD) exacerbations, pneumonia, bacteremia (specially those caused by Gram-negative bacilli), and invasive fungal infections [ 6 , 14 ]. Tumor progression and lung cancer are associated with a worse prognosis [ 6 , 30 , 31 ].…”

“…In three contemporary series, the frequency of unexpected serious complications in apparently stable individuals in the first 3 h was 7.3–18.6% [ 25 , 29 ]. The Clinical Index of Stable Febrile Neutropenia (CISNE) (Table 2 ) was developed and validated for the Western population to predict serious complications (shock, acute organ failure, arrhythmia, major bleeding, delirium, disseminated intravascular coagulation, acute abdomen), in the subgroup of patients with solid tumors who have undergone mild–moderate-intensity chemotherapy and who appear to be clinically stable at the onset of the episodes [II, B] [ 14 , 25 , 26 , 29 ]. Its application requires having previously ruled out hemodynamic instability or clinical risk of complications by means of vital signs, anamnesis, physical examination, and laboratory data (Table 3 ).…”

Incidence, Diagnosis, and Treatment of Cardiac Toxicity From Trastuzumab in Patients With Breast Cancer

“…Expert consensus recommendations suggest treatment with first-line heart failure medications and early cardiology consultation if symptoms or signs of trastuzumab-induced cardiotoxicity develop (80). ACEIs/ARBs and BBs are appropriate first-line agents followed by loop diuretics, hydralazine-nitrates, and aldosterone antagonists per the ACC/AHA guidelines (79).…”

“…Referral to a cardiologist is recommended once an abnormal baseline LVEF or significant decrease in LVEF during monitoring is noted to ensure early treatment of myocardial injury (80). Additionally, referral to a cardio-oncology provider prior to initiation of trastuzumab based therapy in those at highest risk for developing trastuzumab-induced cardiac complications is recommended.…”