Implementation of international good clinical practice guidelines to improve care of patients with cancer-related venous thromboembolism

Abstract

Over the past 20 years, venous thromboembolism (VTE) has become the second cause of death in cancer patients, where it accounts for increased morbidity, mortality, and health-care costs. Incidental VTE is increasingly diagnosed on systematic computed tomography scan evaluations, raising new questions in daily oncology practice. The exact mechanisms underlying the increase in cancer-related VTE are not fully understood. Risk factors include patient-related, cancer-related, and treatment-related parameters which vary for a single patient throughout cancer disease and which require repeated individual risk assessments. Cumulative results from studies in cancer patients with versus without VTE suggest that anticoagulation therapy prevents morbidity and may reduce mortality. However, despite the availability of effective and safe therapeutic options, VTE is often underrecognized and sub-optimally managed. Clinical practice guidelines addressing the management of VTE in cancer patients are heterogeneous and require adequate educational and active implementation strategies. This review, resulting from an extensive literature search, aims to summarize the recently published evidence-based guidelines for treatment and prophylaxis of cancer-related VTE, as well as the place of new oral anticoagulants in the treatment strategies. Adherence to guidelines could substantially decrease the burden of VTE and increase survival in cancer patients.