open access

Vol 52, No 4 (2021)
Review article
Submitted: 2021-07-23
Accepted: 2021-07-23
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Prevention and treatment of venous thromboembolism in patients with hematological neoplasms

Joanna Rupa-Matysek1
DOI: 10.5603/AHP.2021.0080
·
Acta Haematol Pol 2021;52(4):429-435.
Affiliations
  1. Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland

open access

Vol 52, No 4 (2021)
REVIEW ARTICLE
Submitted: 2021-07-23
Accepted: 2021-07-23

Abstract

Venous thromboembolism (VTE) risk-assessment models are not always useful in predicting VTE risk in patients with hematological neoplasms. Newly updated guidelines recommend primary prevention of VTE in selected patients with cancer using Khorana Risk Score points. The decision to use anticoagulants for primary prophylaxis should be individualized, taking into account the risk of VTE as well as the risk of bleeding. Randomized trials with direct oral anticoagulants (DOACs) have confirmed their safety, good treatment tolerance, and efficacy in both cancer-associated thrombosis (CAT) primary prevention and CAT treatment in cancer patients. In all clinical trials, patients with hematological malignancies have been underrepresented. Individualized use of DOACs for primary thromboprophylaxis should be based on a patient risk/benefit assessment including thrombocytopenia and drug interactions. Although rivaroxaban or apixaban are safe and efficacious for VTE treatment compared to low-molecular-weight heparin, the choice of optimal anticoagulation in patients with hematological malignancies should be individualized and based on the type of malignancy, the bleeding risks, the concomitant medications, and patient preferences. Further research on primary prophylaxis is required, especially in patients with hematological malignancies.

Abstract

Venous thromboembolism (VTE) risk-assessment models are not always useful in predicting VTE risk in patients with hematological neoplasms. Newly updated guidelines recommend primary prevention of VTE in selected patients with cancer using Khorana Risk Score points. The decision to use anticoagulants for primary prophylaxis should be individualized, taking into account the risk of VTE as well as the risk of bleeding. Randomized trials with direct oral anticoagulants (DOACs) have confirmed their safety, good treatment tolerance, and efficacy in both cancer-associated thrombosis (CAT) primary prevention and CAT treatment in cancer patients. In all clinical trials, patients with hematological malignancies have been underrepresented. Individualized use of DOACs for primary thromboprophylaxis should be based on a patient risk/benefit assessment including thrombocytopenia and drug interactions. Although rivaroxaban or apixaban are safe and efficacious for VTE treatment compared to low-molecular-weight heparin, the choice of optimal anticoagulation in patients with hematological malignancies should be individualized and based on the type of malignancy, the bleeding risks, the concomitant medications, and patient preferences. Further research on primary prophylaxis is required, especially in patients with hematological malignancies.

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Keywords

venous thromboembolism (VTE), cancer-associated thrombosis, hematological neoplasms, DOACs, VTE prophylaxis, VTE treatment

About this article
Title

Prevention and treatment of venous thromboembolism in patients with hematological neoplasms

Journal

Acta Haematologica Polonica

Issue

Vol 52, No 4 (2021)

Article type

Review article

Pages

429-435

DOI

10.5603/AHP.2021.0080

Bibliographic record

Acta Haematol Pol 2021;52(4):429-435.

Keywords

venous thromboembolism (VTE)
cancer-associated thrombosis
hematological neoplasms
DOACs
VTE prophylaxis
VTE treatment

Authors

Joanna Rupa-Matysek

References (48)
  1. Timp JF, Braekkan SK, Versteeg HH, et al. Epidemiology of cancer-associated venous thrombosis. Blood. 2013; 122(10): 1712–1723.
  2. Franchini M. Thromboembolic risk in hematological malignancies. Clin Chem Lab Med. 2015; 53(8): 1139–1147.
  3. Kekre N, Connors JM. Venous thromboembolism incidence in hematologic malignancies. Blood Rev. 2019; 33: 24–32.
  4. Khorana AA, Francis CW, Culakova E, et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007; 5(3): 632–634.
  5. Khorana AA, Francis CW, Culakova E, et al. Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study. Cancer. 2005; 104(12): 2822–2829.
  6. Ay C, Pabinger I, Cohen AT. Cancer-associated venous thromboembolism: burden, mechanisms, and management. Thromb Haemost. 2017; 117(2): 219–230.
  7. Falanga A, Schieppati F, Russo L. Pathophysiology 1. Mechanisms of thrombosis in cancer patients. Cancer Treat Res. 2019; 179: 11–36.
  8. Styczyński J, Balwierz W, Wachowiak J, et al. Epidemiology and prevention strategies of SARS-CoV-2 infection in pediatric hematology and oncology centers in Poland. Acta Haematol Pol. 2020; 51(4): 253–257.
  9. Styczyński J. Infections following CAR-T cells therapy: current state-of-the-art review and recommendations. Acta Haematol Pol. 2020; 51(1): 11–16.
  10. Falanga A, Marchetti M. Venous thromboembolism in the hematologic malignancies. J Clin Oncol. 2009; 27(29): 4848–4857.
  11. Falanga A, Marchetti M, Russo L. Venous thromboembolism in the hematologic malignancies. Curr Opin Oncol. 2012; 24(6): 702–710.
  12. Cortelezzi A, Moia M, Falanga A, et al. CATHEM Study Group. Incidence of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study. Br J Haematol. 2005; 129(6): 811–817.
  13. Khorana AA, Cohen AT, Carrier M, et al. Prevention of venous thromboembolism in ambulatory patients with cancer. ESMO Open. 2020; 5(6): e000948.
  14. Caruso V, Di Castelnuovo A, Meschengieser S, et al. Thrombotic complications in adult patients with lymphoma: a meta-analysis of 29 independent cohorts including 18 018 patients and 1149 events. Blood. 2010; 115(26): 5322–5328.
  15. Gil L, Łojko-Dankowska A, Matuszak M, et al. CAR-T cell therapy — toxicity and its management. Acta Haematol Pol. 2020; 51(1): 6–10.
  16. Styczyński J. A brief history of CAR-T cells: from laboratory to the bedside. Acta Haematol Pol. 2020; 51(1): 2–5.
  17. Samuelson Bannow BR, Lee AYY, Khorana AA, et al. Management of anticoagulation for cancer-associated thrombosis in patients with thrombocytopenia: A systematic review. Res Pract Thromb Haemost. 2018; 2(4): 664–669.
  18. Prandoni P, Lensing A, Piccioli A, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002; 100(10): 3484–3488.
  19. Angelini DE, Radivoyevitch T, McCrae KR, et al. Bleeding incidence and risk factors among cancer patients treated with anticoagulation. Am J Hematol. 2019; 94(7): 780–785.
  20. Riedl J, Kaider A, Reitter EM, et al. Association of mean platelet volume with risk of venous thromboembolism and mortality in patients with cancer. Results from the Vienna Cancer and Thrombosis Study (CATS). Thromb Haemost. 2014; 111(4): 670–678.
  21. Pabinger I, Thaler J, Ay C. Biomarkers for prediction of venous thromboembolism in cancer. Blood. 2013; 122(12): 2011–2018.
  22. Rupa-Matysek J, Gil L, Kroll-Balcerzak R, et al. Mean platelet volume as a predictive marker for venous thromboembolism and mortality in patients treated for diffuse large B-cell lymphoma. Hematol Oncol. 2017; 35(4): 456–464.
  23. Rupa-Matysek J, Gil L, Barańska M, et al. Mean platelet volume as a predictive marker for venous thromboembolism in patients treated for Hodgkin lymphoma. Oncotarget. 2018; 9(30): 21190–21200.
  24. Timp JF, Lijfering WM, Rosendaal FR, et al. Risk prediction of recurrent venous thrombosis; where are we now and what can we add? J Thromb Haemost. 2019; 17(9): 1527–1534.
  25. Khorana AA, Kuderer NM, Culakova E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008; 111(10): 4902–4907.
  26. Mulder FI, Candeloro M, Kamphuisen PW, et al. CAT-prediction collaborators. The Khorana score for prediction of venous thromboembolism in cancer patients: a systematic review and meta-analysis. Haematologica. 2019; 104(6): 1277–1287.
  27. Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2020; 38(5): 496–520.
  28. Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021; 5(4): 927–974.
  29. Verso M, Di Nisio M. Management of venous thromboembolism in cancer patients: considerations about the clinical practice guideline update of the American Society of Clinical Oncology. Eur J Intern Med. 2020; 71: 4–7.
  30. Farge D, Frere C, Connors JM, et al. International Initiative on Thrombosis and Cancer (ITAC) advisory panel. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2019; 20(10): e566–e581.
  31. https://www.nccn.org/professionals/physician_gls/pdf/vte.pdf (July 26, 2021).
  32. Rupa-Matysek J, Gil L, Kaźmierczak M, et al. Prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies: validation of the Khorana Risk Score. Med Oncol. 2017; 35(1): 5.
  33. Antic D, Milic N, Nikolovski S, et al. Development and validation of multivariable predictive model for thromboembolic events in lymphoma patients. Am J Hematol. 2016; 91(10): 1014–1019.
  34. Rupa-Matysek J, Brzeźniakiewicz-Janus K, Gil L, et al. Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice. Cancer Med. 2018 [Epub ahead of print]; 7(7): 2868–2875.
  35. Agnelli G, Verso M, Mandalà M, et al. A prospective study on survival in cancer patients with and without venous thromboembolism. Intern Emerg Med. 2014; 9(5): 559–567.
  36. Moik F, Makatsariya A, Ay C. Challenging anticoagulation cases: cancer-associated venous thromboembolism and chemotherapy-induced thrombocytopenia - A case-based review of clinical management. Thromb Res. 2021; 199: 38–42.
  37. Leader A, Ten Cate V, Ten Cate-Hoek AJ, et al. Anticoagulation in thrombocytopenic patients with hematological malignancy: a multinational clinical vignette-based experiment. Eur J Intern Med. 2020; 77: 86–96.
  38. Napolitano M, Saccullo G, Marietta M, et al. Gruppo Italiano Malattie EMatologiche dell’Adulto (GIMEMA) Working Party on Thrombosis and Hemostasis, Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) Working Party on Thrombosis and Haemostasis (see Appendix 1). Platelet cut-off for anticoagulant therapy in thrombocytopenic patients with blood cancer and venous thromboembolism: an expert consensus. Blood Transfus. 2019; 17(3): 171–180.
  39. Mulder FI, Bosch FTM, Young AM, et al. Direct oral anticoagulants for cancer-associated venous thromboembolism: a systematic review and meta-analysis. Blood. 2020; 136(12): 1433–1441.
  40. Kraaijpoel N, Di Nisio M, Mulder FI, et al. Clinical impact of bleeding in cancer-associated venous thromboembolism: results from the Hokusai VTE cancer study. Thromb Haemost. 2018; 118(8): 1439–1449.
  41. Khan F, Tritschler T, Kahn SR, et al. Venous thromboembolism. Lancet. 2021; 398(10294): 64–77.
  42. Carrier M, Blais N, Crowther M, et al. Treatment algorithm in cancer-associated thrombosis: Canadian expert consensus. Curr Oncol. 2018; 25(5): 329–337.
  43. Chin-Yee N, Tanuseputro P, Carrier M, et al. Thromboembolic disease in palliative and end-of-life care: a narrative review. Thromb Res. 2019; 175: 84–89.
  44. Posch F, Königsbrügge O, Zielinski C, et al. Treatment of venous thromboembolism in patients with cancer: a network meta-analysis comparing efficacy and safety of anticoagulants. Thromb Res. 2015; 136(3): 582–589.
  45. Lee AYY, Levine MN, Baker RI, et al. Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003; 349(2): 146–153.
  46. Yan YD, Ding Z, Pan MM, et al. Net clinical benefit of direct oral anticoagulants in patients with cancer and venous thromboembolism: a systematic review and trade-off analysis. Front Cardiovasc Med. 2020; 7: 586020.
  47. Kraaijpoel N, Di Nisio M, Mulder FI, et al. Hokusai VTE Cancer Investigators. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018; 378(7): 615–624.
  48. Agnelli G, Buller HR, Cohen A, et al. AMPLIFY Investigators. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013; 369(9): 799–808.

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