New prophylaxis strategies to reduce the risk of thromboembolism in cancer

ABSTRACT

Introduction: Patients with cancer are at risk of thrombotic events, mainly deep vein thrombosis and/or pulmonary embolism. The thrombosis risk is generally 4–6 times higher than in a healthy population and depends on factors related to patient characteristics, tumor factors, and treatment-related factors. The decision-making for prophylactic anticoagulation is individualized according to the relative risks and benefits. The VTE risk has been quantified using different assessment scores.

Areas covered: This article reviews current data and ongoing research on predictive factors involved in cancer-related thrombosis and highlights the currently suggested strategies for prophylaxis. Several trials that compared the two treatment options, direct factor Xa inhibitor or LMWH, with placebo and not each other are discussed. This article analyzed the safety and efficacy features that led several international organizations such as ASCO, NCCN, and others, to issue guidelines for the prophylaxis and treatment of patients at high risk of thrombosis by using LMWH, fondaparinux, and DOACs.

Expert opinion: ASCO, NCCN, and other international organizations recommend thromboprophylaxis in high-risk patients. However, further investigation is needed to define better biomarkers for more accurate identification of cancer patients that will benefit from anticoagulant treatment.

KEYWORDS:

• Cancer
• thrombosis
• management
• low-molecular-weight heparin

Article highlights

• Patients with cancer are at risk for thrombotic events

• The decision-making for prophylactic anticoagulation is individualized according to the relative risks and benefits

• Guidelines for prophylaxis and treatment have been proposed, as a result of large randomized multicenter studies comparing anticoagulant therapy models

• For ambulatory patients at high risk for VTE, the prophylactic use of either a direct factor Xa inhibitor or LMWH should be considered

• For hospitalized patients with cancer, the administration of anticoagulant thromboprophylaxis is considered standard practice and strongly recommended in clinical guidelines, except hospitalized cancer patients for minor procedures or short chemotherapy infusion

• Concerning the DOACs, there are two large trials, with some of the most common cancers underrepresented. Therefore, the results are considered inconclusive and cannot be generalized.

Acknowledgments

Special thanks are given to Ms Vasso Athanasaki for her scientific secretary assistance.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper received no funding.