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      Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

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          Abstract

          PURPOSE

          To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer.

          METHODS

          PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommendations as needed.

          RESULTS

          The systematic review included 35 publications on VTE prophylaxis and treatment and 18 publications on VTE risk assessment. Two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in patients with cancer reported that edoxaban and rivaroxaban are effective but are linked with a higher risk of bleeding compared with low-molecular-weight heparin (LMWH) in patients with GI and potentially genitourinary cancers. Two additional RCTs reported on DOACs for thromboprophylaxis in ambulatory patients with cancer at increased risk of VTE.

          RECOMMENDATIONS

          Changes to previous recommendations: Clinicians may offer thromboprophylaxis with apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban and edoxaban have been added as options for VTE treatment; patients with brain metastases are now addressed in the VTE treatment section; and the recommendation regarding long-term postoperative LMWH has been expanded. Re-affirmed recommendations: Most hospitalized patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE. Additional information is available at www.asco.org/supportive-care-guidelines .

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          Most cited references131

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          Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update

          Betty Ferrell, Jennifer Temel, Sarah Temin … (2017)
          Article 0 comments Cited 337 times – based on 0 reviews     Review now
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            Epidemiology of venous thromboembolism.

            John Heit (2015)
            Thrombosis can affect any venous circulation. Venous thromboembolism (VTE) includes deep-vein thrombosis of the leg or pelvis, and its complication, pulmonary embolism. VTE is a fairly common disease, particularly in older age, and is associated with reduced survival, substantial health-care costs, and a high rate of recurrence. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors. Major risk factors for incident VTE include hospitalization for surgery or acute illness, active cancer, neurological disease with leg paresis, nursing-home confinement, trauma or fracture, superficial vein thrombosis, and-in women-pregnancy and puerperium, oral contraception, and hormone therapy. Although independent risk factors for incident VTE and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be fairly constant, or even increasing.
            Article 0 comments Cited 294 times – based on 0 reviews     Review now
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              Development and validation of a predictive model for chemotherapy-associated thrombosis.

              Alok A. Khorana, Nicole M Kuderer, Eva Culakova … (2008)
              Risk of venous thromboembolism (VTE) is elevated in cancer, but individual risk factors cannot identify a sufficiently high-risk group of outpatients for thromboprophylaxis. We developed a simple model for predicting chemotherapy-associated VTE using baseline clinical and laboratory variables. The association of VTE with multiple variables was characterized in a derivation cohort of 2701 cancer outpatients from a prospective observational study. A risk model was derived and validated in an independent cohort of 1365 patients from the same study. Five predictive variables were identified in a multivariate model: site of cancer (2 points for very high-risk site, 1 point for high-risk site), platelet count of 350 x 10(9)/L or more, hemoglobin less than 100 g/L (10 g/dL) and/or use of erythropoiesis-stimulating agents, leukocyte count more than 11 x 10(9)/L, and body mass index of 35 kg/m(2) or more (1 point each). Rates of VTE in the derivation and validation cohorts, respectively, were 0.8% and 0.3% in low-risk (score = 0), 1.8% and 2% in intermediate-risk (score = 1-2), and 7.1% and 6.7% in high-risk (score >/= 3) category over a median of 2.5 months (C-statistic = 0.7 for both cohorts). This model can identify patients with a nearly 7% short-term risk of symptomatic VTE and may be used to select cancer outpatients for studies of thromboprophylaxis.
              Article 0 comments Cited 279 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Journal of Clinical Oncology
                Abbreviated Title: JCO
                Publisher: American Society of Clinical Oncology (ASCO)
                ISSN (Print): 0732-183X
                ISSN (Electronic): 1527-7755
                Publication date Created: February 10 2020
                Publication date (Print): February 10 2020
                Volume: 38
                Issue: 5
                Pages: 496-520
                Affiliations
                [1 ]University of North Carolina, Chapel Hill, NC
                [2 ]Cleveland Clinic, Cleveland, OH
                [3 ]Advanced Cancer Research Group and University of Washington, Seattle, WA
                [4 ]American Society of Clinical Oncology, Alexandria, VA
                [5 ]BC Cancer Agency, Vancouver, British Columbia, Canada
                [6 ]University of Granada, Granada, Spain
                [7 ]Dartmouth-Hitchcock Medical Center, Lebanon, NH
                [8 ]Penn State Cancer Institute, Hershey, PA
                [9 ]Emory University, Atlanta, GA
                [10 ]James P Wilmot Cancer Center and University of Rochester, Rochester, NY
                [11 ]Patient Representative, Denver, CO
                [12 ]Thrombosis Research Institute and University College, London, United Kingdom
                [13 ]McMaster University, Hamilton, Ontario, Canada
                [14 ]University of Southern California and Norris Comprehensive Cancer Center, Los Angeles, CA
                [15 ]University of California, San Francisco, San Francisco, CA
                [16 ]Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA
                [17 ]Hospital Papa Giovanni XXIII, Bergamo; and University of Milan Bicocca, Milan, Italy
                Article
                DOI: 10.1200/JCO.19.01461
                PubMed ID: 31381464
                SO-VID: 2967e449-5d4c-4e10-905b-dce0f4f2e5f4
                Copyright © © 2020
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