scholarly journals Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

2013 ◽  
Vol 31 (17) ◽  
pp. 2189-2204 ◽  
Author(s):  
Gary H. Lyman ◽  
Alok A. Khorana ◽  
Nicole M. Kuderer ◽  
Agnes Y. Lee ◽  
Juan Ignacio Arcelus ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Oral Anticoagulants ◽  
Signs And Symptoms ◽  
Cochrane Collaboration ◽  
Secondary Prophylaxis ◽  
Thromboembolism Prophylaxis ◽  
Eligibility Criteria ◽  
Vein Thrombosis ◽  
Patients With Cancer

Purpose To provide recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. Prophylaxis in the outpatient, inpatient, and perioperative settings was considered, as were treatment and use of anticoagulation as a cancer-directed therapy. Methods A systematic review of the literature published from December 2007 to December 2012 was completed in MEDLINE and the Cochrane Collaboration Library. An Update Committee reviewed evidence to determine which recommendations required revision. Results Forty-two publications met eligibility criteria, including 16 systematic reviews and 24 randomized controlled trials. Recommendations Most hospitalized patients with cancer require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for outpatients with cancer. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low–molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major cancer surgery should receive prophylaxis, starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term (6 months) secondary prophylaxis. Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE. Anticoagulation should not be used for cancer treatment in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should provide patient education about the signs and symptoms of VTE.

scholarly journals Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014

2015 ◽  
Vol 33 (6) ◽  
pp. 654-656 ◽  
Author(s):  
Gary H. Lyman ◽  
Kari Bohlke ◽  
Alok A. Khorana ◽  
Nicole M. Kuderer ◽  
Agnes Y. Lee ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Oral Anticoagulants ◽  
Signs And Symptoms ◽  
Pelvic Surgery ◽  
Cochrane Library ◽  
Major Surgery ◽  
Thromboembolism Prophylaxis ◽  
Patients With Cancer

Purpose To provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. Methods PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from November 2012 through July 2014. An update committee reviewed the identified abstracts. Results Of the 53 publications identified and reviewed, none prompted a change in the 2013 recommendations. Recommendations Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization. Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low–molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis (at least 6 months). Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer. Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should educate patients about the signs and symptoms of VTE.

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

2020 ◽  
Vol 38 (5) ◽  
pp. 496-520 ◽  
Author(s):  
Nigel S. Key ◽  
Alok A. Khorana ◽  
Nicole M. Kuderer ◽  
Kari Bohlke ◽  
Agnes Y.Y. Lee ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Medical Condition ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Signs And Symptoms ◽  
Cochrane Library ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Increased Risk

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 .

First-Line Therapies for VTE Treatment and Secondary Prophylaxis in Patients With Cancer: A New Direction

2018 ◽  
Vol 33 (3) ◽  
pp. 356-363
Author(s):  
Samantha M. Vogel ◽  
Leticia V. Smith ◽  
Evan J. Peterson
Keyword(s):  
Venous Thromboembolism ◽  
English Language ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Secondary Prophylaxis ◽  
Careful Consideration ◽  
Patients With Cancer ◽  
Study Selection ◽  
Meta Analyses

Objective: To review evidence behind anticoagulants in cancer-associated venous thromboembolism (VTE) with a focus on low-molecular-weight heparins (LMWH) and the role of direct oral anticoagulants (DOACs). Data Sources: PubMed was searched using terms “venous thromboembolism,” “cancer,” and “anticoagulation.” This search was restricted to clinical trials, meta-analyses, and subgroup analyses. Additional references were identified from reviewing literature citations. Study Selection: English-language prospective and retrospective studies assessing the efficacy and safety of LMWH and DOACs in patients with cancer. Data Analysis: Several trials were analyzed that compared anticoagulation therapies for prevention of recurrent VTE in patients with cancer. Many studies comparing LMWH and vitamin K antagonists (VKAs) found nonsignificant differences between therapies. A single study demonstrated that LMWHs are superior to VKAs. This evidence supporting LMWH for long-term VTE treatment in patients with cancer is based on comparison to VKA, but results are limited by methodological issues, and the benefit of LMWH may be driven by poor control. Subanalyses of DOAC trials suggest these are equally or more effective as VKA in cancer, but this conclusion is underpowered. Conclusion: DOACs have the potential to bypass many challenges with traditional therapy. After analyzing the evidence available, we conclude that after careful consideration of risks and benefits, use of DOACs for VTE treatment are a reasonable option in patients with cancer.

scholarly journals Does aspirin prevent venous thromboembolism?

Hematology ◽  
2020 ◽  
Vol 2020 (1) ◽  
pp. 634-641
Author(s):  
Robert Diep ◽  
David Garcia
Keyword(s):  
Venous Thromboembolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Secondary Prophylaxis ◽  
Treatment Modalities ◽  
Surgical Patient ◽  
Vein Thrombosis ◽  
Disease Therapy ◽  
Deep Vein ◽  
Arterial Vascular Disease

Abstract Venous thromboembolism (VTE; deep vein thrombosis and/or pulmonary embolism) is a well-established cause of morbidity and mortality in the medical and surgical patient populations. Clinical research in the prevention and treatment of VTE has been a dynamic field of study, with investigations into various treatment modalities ranging from mechanical prophylaxis to the direct oral anticoagulants. Aspirin has long been an inexpensive cornerstone of arterial vascular disease therapy, but its role in the primary or secondary prophylaxis of VTE has been debated. Risk-benefit tradeoffs between aspirin and anticoagulants have changed, in part due to advances in surgical technique and postoperative care, and in part due to the development of safe, easy-to-use oral anticoagulants. We review the proposed mechanisms in which aspirin may act on venous thrombosis, the evidence for aspirin use in the primary and secondary prophylaxis of VTE, and the risk of bleeding with aspirin as compared with anticoagulation.

Spotlight on advances in VTE management: CALLISTO and EINSTEIN CHOICE

2016 ◽  
Vol 116 (S 02) ◽  
pp. S24-S32 ◽  
Author(s):  
Miriam Bach ◽  
Rupert Bauersachs
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Research Programme ◽  
Phase Iii ◽  
Current Evidence ◽  
Thromboembolism Prophylaxis ◽  
Patients With Cancer ◽  
Patient Reported ◽  
Cancer Associated Thrombosis

SummaryVenous thromboembolism (VTE) is associated with numerous complications and high mortality rates. Patients with cancer are at high risk of developing cancer-associated thrombosis (CAT), and VTE recurrence is common. Evidence supporting use of non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) in patients with cancer is lacking – direct comparisons between NOACs and low-molecular-weight heparin (LMWH) are needed, along with patient-reported outcomes. Cancer Associated thrombosis – expLoring soLutions for patients through Treatment and Prevention with RivarOxaban (CALLISTO) is an international research programme exploring the potential of the direct, oral factor Xa inhibitor rivaroxaban for the prevention and treatment of CAT, supplementing existing data from EINSTEIN DVT and EINSTEIN PE. Here, we focus on four CALLISTO studies: A Study to Evaluate the Efficacy and Safety of Rivaroxaban Venous Thromboembolism Prophylaxis in Ambulatory Cancer Participants receiving Chemotherapy (CASSINI), Antico-agulation Therapy in SELECTeD Cancer Patients at Risk of Recurrence of Venous Thromboembolism (SELECT-D), Rivaroxaban in the Treatment of Venous Thromboembolism in Cancer Patients – a Randomized Phase III Study (CONKO-011) and a database analysis. Optimal anticoagulation duration for VTE treatment has always been unclear. Following favourable results for rivaroxaban 20 mg once-daily (Q. D.) for secondary VTE prevention (EINSTEIN EXT), EINSTEIN CHOICE is assessing rivaroxaban safety and (20 mg Q. D. or 10 mg Q. D.) vs acetylsalicylic acid (ASA), and will investigate whether an alternative rivaroxaban dose (10 mg Q. D.) could offer long-term VTE protection. It is anticipated that results from these studies will provide important answers and expand upon current evidence for rivaroxaban in VTE management.

Variable Support Towards ASCO Recommendations for Venous Thromboembolism (VTE) Prophylaxis and Treatment in Patients with Cancer

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5564-5564
Author(s):  
Axel Matzdorff ◽  
Uwe Schwindel ◽  
Michael Mueller ◽  
Hans Joachim Hutt
Keyword(s):  
Venous Thromboembolism ◽  
Scientific Evidence ◽  
Unmet Need ◽  
Signs And Symptoms ◽  
Daily Practice ◽  
Secondary Prophylaxis ◽  
Pelvic Surgery ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Equity Ownership

Abstract Objectives: To determine the support of physicians for the recently published ASCO evidence-based clinical practice guidelines for venous thromboembolism (VTE) prophylaxis and treatment in patients with cancer (J Clin Oncol. 2015;33:654-6). Methods: ASCO key recommendations were presented as part of three CME seminars to physicians not specialized in hem/onc or hemostasis. In addition two specialists in the field discussed a list of arguments for and against each of the recommendations considering (1) quality of scientific evidence underlying each recommendation, (2) feasibility in daily practice including sensitivity to patients preferences, and (3) medicolegal implications and reimbursement aspects. After each presentation attendees were asked to fill out a questionnaire on how much they supported the ASCO recommendations and each of the pro&con arguments. Results: A total of 89 physicians attended the three meetings. 56 questionnaires were returned. The ASCO recommendations with the highest degree of support were: ‒ Patients undergoing major cancer surgery should receive prophylaxis for 7-10 days and even 4 weeks after major abdominal or pelvic surgery with high-risk features (84% pro) ‒ LMWH should be given for the initial treatment as well as for long-term secondary prophylaxis (80% pro). The recommendations with the lowest degree of support were: ‒ Patients with cancer should be educated about signs and symptoms of VTE. They should be periodically assessed for VTE (59% pro). ‒ Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications (56% pro). Conclusion: After presenting ASCO recommendations as part of CME training the degree of physicians' support was still at best moderate and sometimes even close to neutrality. In daily medical practice scientific evidence has no priority to clinical practicability, patients preferences, medicolegal aspects and cost-restrictions. Guideline authors should complement their recommendations with advice from their own practice on how to implement guidelines in daily care and how they manage financial and medicolegal restrictions. In addition there is an unmet need for more education on VTE prophylaxis and treatment among physicians not specialized in hem/onc or hemostasis who are caring for cancer patients. Disclosures Matzdorff: AMGEN - e. Honoraria: Honoraria; Aspen Germany: Honoraria; Bayer: Equity Ownership; Boehringer Ingelheim: Honoraria; Behring: Honoraria; Bristol Myers Squibb: Honoraria; GlaxoSmithKline: Honoraria; LEO Pharma: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Equity Ownership, Honoraria. Schwindel:LEO Pharma GmbH: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria; Amgen: Honoraria; Nordic Pharma: Honoraria. Hutt:LEO Pharma GmbH: Employment.

PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM IN HIGH RISK SITUATIONS IN PREGNANCY

2005 ◽  
Vol 16 (1) ◽  
pp. 51-70 ◽  
Author(s):  
ANNE G McLEOD ◽  
CAMERON ELLIS
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Pregnant Women ◽  
Signs And Symptoms ◽  
Multiple Gestation ◽  
Vein Thrombosis ◽  
Low Threshold ◽  
Deep Vein ◽  
In Pregnancy

Venous thromboembolism (VTE) is a leading cause of maternal mortality in the western developed world. VTE may present as deep vein thrombosis (DVT) or pulmonary embolism (PE) but if untreated can result in fatal PE. Although fatal PE is clearly the most significant consequence of VTE in pregnancy, DVT also often leads to morbidity related to the development of post-thrombotic syndrome (PTS). Pregnancy is an independent risk factor for VTE and the risk of VTE is 4–10 fold higher in pregnant women than in non-pregnant women of similar age. The puerperium represents a time of even higher risk. It is clear that many additional high-risk situations in pregnancy lower the threshold for thrombosis and warrant measures to prevent VTE and its complications. Risk factors for pregnancy-related VTE may be inherited or acquired. Acquired risk factors may be specifically related to the pregnancy or may have developed prior to pregnancy. Well-documented risk factors for pregnancy-related VTE include delivery by Caesarean section, previous VTE, and inherited or acquired thrombophilia. Other risk factors that have been identified include obesity, multiparity, multiple gestation, pre-eclampsia and medical conditions, such as sickle cell disease, that predispose to VTE. Our ability to diagnose VTE overall is poor as presenting signs and symptoms are extremely varied and unreliable. This is further complicated in pregnancy where signs and symptoms suggestive of VTE are common and invasive testing is more complicated. It is essential that physicians be vigilant in monitoring patients for the development of VTE and maintain a low threshold for considering thromboprophylaxis. Guidelines have recently been published by several medical societies to help with these difficult decisions. In this review the risk factors for the development of VTE in pregnancy will be discussed and guidelines for risk assessment presented. Management of patients who develop VTE in pregnancy is also outlined.

Treatment and secondary prevention of venous thromboembolism in cancer patients

2012 ◽  
Vol 03 (03) ◽  
pp. 121-125
Author(s):  
I. Pabinger ◽  
C. Ay
Keyword(s):  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
New Oral Anticoagulants ◽  
Phase Iii ◽  
Patients With Cancer ◽  
Potential Use

SummaryCancer is a major and independent risk factor of venous thromboembolism (VTE). In clinical practice, a high number of VTE events occurs in patients with cancer, and treatment of cancerassociated VTE differs in several aspects from treatment of VTE in the general population. However, treatment in cancer patients remains a major challenge, as the risk of recurrence of VTE as well as the risk of major bleeding during anticoagulation is substantially higher in patients with cancer than in those without cancer. In several clinical trials, different anticoagulants and regimens have been investigated for treatment of acute VTE and secondary prophylaxis in cancer patients to prevent recurrence. Based on the results of these trials, anticoagulant therapy with low-molecular-weight heparins (LMWH) has become the treatment of choice in cancer patients with acute VTE in the initial period and for extended and long-term anticoagulation for 3-6 months. New oral anticoagulants directly inhibiting thrombin or factor Xa, have been developed in the past decade and studied in large phase III clinical trials. Results from currently completed trials are promising and indicate their potential use for treatment of VTE. However, the role of the new oral thrombin and factor Xa inhibitors for VTE treatment in cancer patients still has to be clarified in further studies specifically focusing on cancer-associated VTE. This brief review will summarize the current strategies of initial and long-term VTE treatment in patients with cancer and discuss the potential use of the new oral anticoagulants.

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