Recent developments and persisting challenges in the prevention and treatment of venous thromboembolism in patients with hematological malignancies

Abstract

Venous thromboembolism (VTE) is a common complication of cancer. Its treatment is challenging because of the high risk for both VTE recurrence and bleeding. Evidence is particularly scarce for patients with hematological malignancies. This review aims to summarize new developments in anticoagulation for the prevention and treatment of VTE in patients with active cancer, largely derived from the formal introduction of direct anticoagulants (DOACs) in this population. We then offer our recommendations for the thromboprophylaxis and treatment of VTE in patients with hematological disorders (mature lymphoid disorders, plasma cell disorders, myeloproliferative neoplasms, myelodysplastic syndrome and acute leukemia/stem cell transplant). We conclude by emphasizing the lack of high-quality evidence in a majority of these settings, caution about the use of DOACs in clinical situations where evidence is lacking and, finally, note the importance of involving patients in the decision-making process.

Keywords:

• Venous thromboembolism
• lymphoma
• myeloma
• leukemia
• direct oral anticoagulant
• low molecular weight heparin

Acknowledgements

The authors thank Dr. Milos Miljkovic for his contribution in the writing of this manuscript.

Disclosure statement

Dr Lopez-Nuñez reports traveling expenses from bayer, Leo Pharma and Sanofi and honoraria from BMS, Rovi and Boehringer.