Update on Guidelines for the Management of Cancer-Associated Thrombosis

Abstract

Cancer-associated thrombosis (CAT) is a major cause of morbidity and mortality in patients with cancer. Over the past 2 decades, enormous advances have been made in the management of CAT. The growing evidence base informing practice has led to the publication of a number of guidelines and guidance documents on the diagnosis and treatment of CAT. The goal of this review is to examine the latest versions of evidence-based guidelines, highlighting the differences and similarities in their methodology, their disease-specific content, and recommendations for management. Our analysis shows that for most clinical topics, the different guidelines provide roughly similar management advice. However, there are a number of important clinical topics in CAT that are not currently covered by the existing guidelines. We think inclusion of these topics in future versions of the guidelines will facilitate ongoing efforts to optimize the care of patients with CAT. The Oncologist 2021;26:e24-e40Implications for Practice: Cancer-associated thrombosis (CAT) is a common complication in patients with cancer. This review examines the differences and similarities of the current CAT guidelines methods and recommendations. Current guidelines largely agree on many aspects of CAT management. However, there are a number of topics in CAT that are not currently included in guidelines where evidence-based guidance would be very helpful for clinicians. Coverage of these topics in future guidelines is encouraged to optimize clinical practice.

Cardiooncology—dealing with modern drug treatment, long-term complications, and cancer survivorship

“…But also new therapeutic approaches as immunomodulatory drugs have been shown to significantly rise the thromboembolic risk [76]. Recent guidelines have incorporated DOACs into the actual treatment recommendations for venous thromboembolism -especially for patients with low bleeding risk who do not have gastrointestinal or genitourinary tract malignancies, severely depressed kidney function or relevant drugdrug interactions [81].…”

Risk Factors and Prediction Models for Venous Thromboembolism in Ambulatory Patients with Lung Cancer

“…Thromboprophylaxis is suggested in hospitalised patients with lung cancer and those undergoing surgery, but the use of primary prevention of VTE in ambulatory patients with lung cancer is still debatable [ 7 ]. Choice of the anticoagulation therapy is particularly challenging in patients undergoing antineoplastic chemotherapy.…”

Direct oral anticoagulants versus low molecular weight heparins for the treatment of cancer-associated thrombosis: a cost-effectiveness analysis

“…Overcoming some of these disadvantages of LMWHs, the so-called direct oral anticoagulants (DOACs) have been recently introduced: dabigatran, rivaroxaban apixaban, and edoxaban [ 17 – 20 ], which represent a convenient and patient-centric anticoagulation strategy. Most notably, more recent recommendations from guidelines on the use of DOACs for the treatment of VTE to be extended to suitable cancer patients [ 21 , 22 ], with emerging data supporting their safety and efficacy in the care of cancer patients [ 23 ]. However, the use of these new oral anticoagulants should be carefully considered in the decision-making process by balancing the clinical benefits and the related costs.…”