Vol 5, No 3 (2014)
Review paper
Published online: 2014-11-20
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Prevention and treatment of cancer-associated venous thromboembolism
Hematologia 2014;5(3):228-238.
Abstract
Large studies suggest that patients with active cancer experience a 4- to 8-fold increase in venous thromboembolism (VTE) compared with the general population. Thromboprophylaxis was reported to significantly reduce the incidence of symptomatic venous thrombosis, however, this treatment was also associated with an increase in bleeding events. Therefore future studies need to be targeted at development and validation of prediction models to categorize cancer patients into high or low riskof venous thrombosis, depending on tumor site, histology, stage, and type of treatment. In accordance with current guidelines thromboprophylaxis should be routinely administered to all hospitalized cancer patients who do not present an increased risk of bleeding. It should be targeted only to ambulatory cancer patients receiving chemotherapy with a high risk of VTE, which outweighs the risk of bleeding events. The overall risk of recurrent venous thrombosis in patients who suffered once from VTE is approximately two- to threefold increased compared with non-cancer patients. In the treatment of VTE low-molecular-weight heparins have supplanted vitamin K antagonists asthe preferred long-term treatment for VTE in cancer patients. An approach to the use of new oral anticoagulants in cancer-associated thrombosis, will be reviewed as well. The incidence of superficial vein thrombosis in cancer patients has not been studied. Whether superficial vein thrombosis should be seen as a marker of occult cancer is also controversial. Patients with an idiopathic VTE have a higher risk of detection of an occult cancer than patients with a venous thrombotic event secondary to a provoking risk factor. The effect of extensive screening in idiopathic VTE patients on prognosis remains elusive. Further studies are needed to investigate whether screening procedures affect cancer-related mortality and are cost-effective.
Keywords: neoplastic diseasevenous thromboembolismthromboprophylaxislow-molecular- -weight heparinnew oral anticoagulantsoccult cancersuperficial vein thrombosis
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