Vnitr Lek 2022, 68(4):221-226 | DOI: 10.36290/vnl.2022.047

Prevention and treatment of cancer associated venous thromboembolism - interdisciplinary consensus

Ivar Vacula1, Zuzana Rusiňáková2, Denisa Čelovská3, Peter Jackuliak4, Ján Slopovský5, Patrik Palacka5, Matej Moščovič6, Stanislav Špánik7, Ján Staško8, Alexander Wild9, Angelika Bátorová10, Juraj Maďarič11
1 Angiologická‑interná ambulancia, Trnava
2 Klinika onkohematológie LF UK a NOÚ, Bratislava
3 I. interná klinika LF UK a UN, Bratislava
4 V. interná klinika LF UK a UN, Bratislava
5 II. onkologická klinika LF UK a NOÚ, Bratislava
6 Klinika angiológie VÚSCH, a. s., Košice
7 I. onkologická klinika LF UK a OÚSA, Bratislava
8 Klinika hematológie a transfuziológie JLF UK Martin
9 Hematologické oddelenie, FNsP F. D. Roosevelta, Banská Bystrica
10 Klinika hematológie a transfúziológie LF UK, SZU a UN, Bratislava
11 Klinika angiológie LF UK a NÚSCH, a. s., Bratislava

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

Published: June 22, 2022  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Vacula I, Rusiňáková Z, Čelovská D, Jackuliak P, Slopovský J, Palacka P, et al.. Prevention and treatment of cancer associated venous thromboembolism - interdisciplinary consensus. Vnitr Lek. 2022;68(4):221-226. doi: 10.36290/vnl.2022.047.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Khorana AA. Venous thromboembolism and prognosis in cancer. Thromb Res. 2010;125:490-493. Go to original source... Go to PubMed...
    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. Go to original source... Go to PubMed...
    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. Go to original source... Go to PubMed...
    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. Go to original source... Go to PubMed...
    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. Go to original source... Go to PubMed...
    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. Go to original source... Go to PubMed...
    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. Go to original source... Go to PubMed...
    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. Go to original source... Go to PubMed...
    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. Go to original source... Go to PubMed...
    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.Další literatura u autorů a na www.casopisvnitrnilekarstvi.cz Go to original source... Go to PubMed...
    11. Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, Rickles FR, Julian JA, Haley S, Kovacs MJ, Gent M; 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 Jul 10;349(2):146-53. doi: 10.1056/NEJMoa025313. PMID: 12853587. Go to original source... Go to PubMed...
    12. Lee AYY, Kamphuisen PW, Meyer G, Bauersachs R, Janas MS, Jarner MF, Khorana AA; CATCH Investigators. Tinzaparin vs Warfarín for Treatment of Acute Venous Thromboembolism in Patients With Active Cancer: A Randomized Clinical Trial. JAMA. 2015 Aug 18;314(7):677-686. doi: 10.1001/jama.2015.9243. Erratum in: JAMA. 2017 Nov 28;318(20):2048. PMID: 26284719. Go to original source... Go to PubMed...
    13. Kamphuisen PW, Lee AYY, Meyer G, Bauersachs R, Janas MS, Jarner MF, Khorana AA; CATCH Investigators. Clinically relevant bleeding in cancer patients treated for venous thromboembolism from the CATCH study. J Thromb Haemost. 2018 Jun;16(6):1069-1077. doi: 10.1111/jth.14007. Epub 2018 Apr 17. PMID: 29573330. Go to original source... Go to PubMed...
    14. Kraaijpoel N, Di Nisio M, Mulder FI, van Es N, Beyer‑Westendorf J, Carrier M, Garcia D, Grosso M, Kakkar AK, Mercuri MF, Middeldorp S, Hernandez CR, Santamaria A, Schwocho L, Segers A, Verhamme P, Wang TF, Weitz JI, Zhang G, Zwicker JI, Büller HR, Raskob GE. Clinical Impact of Bleeding in Cancer‑Associated Venous Thromboembolism: Results from the Hokusai VTE Cancer Study. Thromb Haemost. 2018 Aug;118(8):1439-1449. doi: 10.1055/s-0038-1667001. Epub 2018 Jul 30. PMID: 30060256. Go to original source... Go to PubMed...
    15. Young AM, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, Hale D, Dunn JA, Lyman GH, Hutchinson C, MacCallum P, Kakkar A, Hobbs FDR, Petrou S, Dale J, Poole CJ, Maraveyas A, Levine M. Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT‑D). J Clin Oncol. 2018 Jul 10;36(20):2017-2023. doi: 10.1200/JCO.2018. 78. 8034. Epub 2018 May 10. PMID: 29746227. Go to original source...
    16. Agnelli G, Becattini C, Bauersachs R, Brenner B, Campanini M, Cohen A, Connors JM, Fontanella A, Gussoni G, Huisman MV, Lambert C, Meyer G, Muñoz A, Abreu de Sousa J, Torbicki A, Verso M, Vescovo G; Caravaggio Study Investigators. Apixaban versus Dalteparin for the Treatment of Acute Venous Thromboembolism in Patients with Cancer: The Caravaggio Study. Thromb Haemost. 2018 Sep;118(9):1668-1678. doi: 10.1055/s-0038-1668523. Epub 2018 Aug 13. PMID: 30103252. Go to original source... Go to PubMed...
    17. Mazzolai L, Ageno W, Alatri A, Bauersachs R, Becattini C, Brodmann M, Emmerich J, Konstantinides S, Meyer G, Middeldorp S, Monreal M, Righini M, Aboyans V. Second consensus document on diagnosis and management of acute deep vein thrombosis: updated document elaborated by the ESC Working Group on aorta and peripheral vascular diseases and the ESC Working Group on pulmonary circulation and right ventricular function. Eur J Prev Cardiol. 2021 Jul 13:zwab088. doi: 10.1093/eurjpc/zwab088. Epub ahead of print. PMID: 34254133. Go to original source... Go to PubMed...
    18. Khorana, AA, Noble, S, Lee, AYY, Soff, G, Meyer, G, O'Connell, C, Carrier, M. Role of direct oral anticoagulants in the treatment of cancer‑associated venous thromboembolism: guidance from the SSC of the ISTH. J Thromb Haemost. 2018;16:1891-4. Go to original source... Go to PubMed...

    Return to the content


    Vnitřní lékařství

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.