Prediction and Prevention of Cancer-Associated Thromboembolism

The oncologist

article

Alok A. Khorana¹  Maria T. DeSancho²  Howard Liebman³  Rachel Rosovsky⁴  Jean M. Connors⁵  Jeffrey Zwicker⁶ 

[1] Department of Hematology and Medical Oncology, Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic;Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital;Jane Anne Nohl Division of Hematology, Department of Medicine, University of Southern California - Keck School of Medicine;Division of Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School;Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School;Division of Hematology, Beth Israel Deaconess Medical Center, Harvard Medical School

关键词: Cancer-associated thrombosis;    Risk assessment;    Prevention;    Venous thromboembolism;    Arterial thromboembolism;   

DOI  :  10.1002/onco.13569

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Venous and arterial thromboembolism are prevalent, highly burdensome, and associated with risk of worse outcomes for patients with cancer. Risk for venous thromboembolism (VTE) varies widely across specific cancer subpopulations. The ability to predict risk of cancer-associated VTE is critical because an optimal thromboprophylaxis strategy is best achieved by targeting high-risk patients with cancer and avoiding prophylaxis in patients with cancer at low risk for VTE. A validated risk tool for solid tumors has been available for a decade. Newer tools have focused on specific populations, such as patients with multiple myeloma. Emerging studies continue to optimize risk prediction approaches in patients with cancer. Recent randomized trials have specifically addressed risk-adapted thromboprophylaxis using direct oral anticoagulants, and revised guidelines have included these new data to formulate recommendations for outpatient thromboprophylaxis. Implementation science approaches to enhance use of outpatient prophylaxis in the context of these guideline changes are under way. However, major knowledge gaps remain, including a lack of data for inpatient thromboprophylaxis in the cancer setting and a lack of formal tools for identifying risk of bleeding. This review describes optimal approaches to risk prediction and patient selection for primary pharmacologic thromboprophylaxis of cancer-associated VTE, addresses barriers to implementing these practices, and highlights strategies to overcome them. Implications for Practice Risk for venous thromboembolism (VTE) varies widely among patients with cancer. Individual risk can be determined using validated approaches. Inpatient and postsurgical thromboprophylaxis is more widely accepted. However, most patients with cancer develop VTE in the outpatient setting. Recent randomized trials have demonstrated benefit to risk-adapted outpatient thromboprophylaxis. High-risk patients may therefore be considered for outpatient thromboprophylaxis as recommended by recently updated guidelines. System-wide implementation approaches are necessary to improve compliance with prophylaxis.

【 授权许可】

CC BY|CC BY-NC