Prevention and treatment of cancer associated venous thromboembolism – interdisciplinary consensus

Česká verzia

Authors: Ivar Vacula ¹; Zuzana Rusiňáková ²; Denisa Čelovská ³; Peter Jackuliak ⁴; Ján Slopovský ⁵; Patrik Palacka ⁵; Matej Moščovič ⁶; Stanislav Špánik ⁷; Ján Staško ⁸; Alexander Wild ⁹; Angelika Bátorová ¹⁰; Juraj Ma Arič ¹¹
Authors place of work: Angiologická‑interná ambulancia, Trnava ¹; Klinika onkohematológie LF UK a NOÚ, Bratislava ²; I. interná klinika LF UK a UN, Bratislava ³; V. interná klinika LF UK a UN, Bratislava ⁴; II. onkologická klinika LF UK a NOÚ, Bratislava ⁵; Klinika angiológie VÚSCH, a. s., Košice ⁶; I. onkologická klinika LF UK a OÚSA, Bratislava ⁷; Klinika hematológie a transfuziológie JLF UK Martin ⁸; Hematologické oddelenie, FNsP F. D. Roosevelta, Banská Bystrica ⁹; Klinika hematológie a transfúziológie LF UK, SZU a UN, Bratislava ¹⁰; Klinika angiológie LF UK a NÚSCH, a. s., Bratislava ¹¹
Published in the journal: Vnitř Lék 2022; 68(4): 221-226
Category: Review Articles

Summary

The increasing volume of the data and experience with direct oral anticoagulants (DOACS) in the primary and secondary prevention of venous thromboembolism in oncologic patients (CAVTE) has recently lead to changes in several international guidelines. We reflect these changes within the conditions in Slovak republic. In the primary prevention of CAVTE we recognise oncosurgical patients and nonsurgical patients: hospitalised and out patients. Low molecular weight heparins are still dominant in the primary prevention of CAVTE. Regarding the treatment and the secondary prevention of CAVTE, we recommend always to consider the possibility to use DOACs as they proved to be non inferior to LMWH. However, LMWH should be prefered over DOACs as well as over warfarin (VKA) in all patients who are in a clinically unstable condition with the high risk of bleeding and/or interaction with the systemic treatment. Primarily in the patients with intraluminal tumours of the upper part of the gastrointestinal tract and genitourinary tumours with the high risk of bleeding. As for the lack of data, LMWH are still preferd also in patients with primary tumours and metastatic disease of the central nervous system and in hemato oncology.

Keywords:

low molecular weight heparin (LMWH) – bleeding – venous thromboembolism (VTE – CAVTE) – oncological disease – direct oral anticoagulant (DOAC)

Zdroje

1. Khorana AA. Venous thromboembolism and prognosis in cancer. Thromb Res. 2010;125:490–493.

2. Schaefer JK, Elshoury A, Nachar VR, Streiff MB, Lim MY. How to Choose An Appropriate Anticoagulant for Cancer‑Associated Thrombosis. J Natl Compr Canc Netw. 2021 Oct 15;19(10):1203-1210. doi: 10.6004/jnccn.2021.7085. PMID: 34666314.

3. Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA, Leavitt AD, Lee AYY, Macbeth F, Morgan RL, Noble S, Sexton EA, Stenehjem D, Wiercioch W, Kahale LA, Alonso‑Coello P. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021 Feb 23;5(4):927-974. doi: 10.1182/bloodadvances.2020003442. Erratum in: Blood Adv. 2021 Apr 13;5(7):1953. PMID: 33570602; PMCID: PMC7903232.

4. Streiff MB, Holmstrom B, Angelini D, Ashrani A, Elshoury A, Fanikos J, Fertrin KY, Fogerty AE, Gao S, Goldhaber SZ, Gundabolu K, Ibrahim I, Kraut E, Leavitt AD, Lee A, Lee JT, Lim M, Mann J, Martin K, McMahon B, Moriarty J, Morton C, Ortel TL, Paschal R, Schaefer J, Shattil S, Siddiqi T, Sudheendra D, Williams E, Hollinger L, Nguyen MQ. Cancer‑Associated Venous Thromboembolic Disease, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021 Oct 15;19(10):1181-1201. doi: 10.6004/jnccn.2021.0047. PMID: 34666313.

5. Venclauskas, L, Maleckas A, Arcelus JI. European guidelines on perioperative venous thromboembolism prophylaxis. Surgery in the obese patients. Eur J Anaesthesiol 2018; 35: 147-153.

6. Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy‑associated thrombosis. Blood. 2008 May 15;111(10):4902-7. doi: 10.1182/blood-2007-10-116327. Epub 2008 Jan 23. PMID: 18216292; PMCID: PMC2384124.

7. Carrier M, Abou‑Nassar K, Mallick R, Tagalakis V, Shivakumar S, Schattner A, Kuruvilla P, Hill D, Spadafora S, Marquis K, Trinkaus M, Tomiak A, Lee AYY, Gross PL, Lazo‑Langner A, El‑Maraghi R, Goss G, Le Gal G, Stewart D, Ramsay T, Rodger M, Witham D, Wells PS; AVERT Investigators. Apixaban to Prevent Venous Thromboembolism in Patients with Cancer. N Engl J Med. 2019 Feb 21;380(8):711-719. doi: 10.1056/NEJMoa1814468. Epub 2018 Dec 4. PMID: 30511879.

8. Khorana AA, Soff GA, Kakkar AK, Vadhan‑Raj S, Riess H, Wun T, Streiff MB, Garcia DA, Liebman HA, Belani CP, O‘Reilly EM, Patel JN, Yimer HA, Wildgoose P, Burton P, Vijapurkar U, Kaul S, Eikelboom J, McBane R, Bauer KA, Kuderer NM, Lyman GH; CASSINI Investigators. Rivaroxaban for Thromboprophylaxis in High‑Risk Ambulatory Patients with Cancer. N Engl J Med. 2019 Feb 21;380(8):720-728. doi: 10.1056/NEJMoa1814630. PMID: 30786186.

9. Wang TF, Zwicker JI, Ay C, Pabinger I, Falanga A, Antic D, Noble S, Khorana AA, Carrier M, Meyer G. The use of direct oral anticoagulants for primary thromboprophylaxis in ambulatory cancer patients: Guidance from the SSC of the ISTH. J Thromb Haemost. 2019 Oct;17(10):1772-1778. doi: 10.1111/jth.14564. Epub 2019 Jul 28. PMID: 31353841; PMCID: PMC6773470.

10. Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, Wong SL, Balaban EP, Flowers CR, Francis CW, Gates LE, Kakkar AK, Levine MN, Liebman HA, Tempero MA, Lyman GH, Falanga A. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020 Feb 10;38(5):496-520. doi: 10.1200/JCO.19.01461. Epub 2019 Aug 5. PMID: 31381464.

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