Prevention and Treatment of Cancer-Associated Venous Thromboembolism: a Review.

Abstract

Patients with cancer have an increased risk of venous thromboembolism (VTE). Cancer-associated VTE is associated with an increased risk of morbidity and mortality. Treatment of VTE in cancer is associated with higher rates of recurrent thrombosis as well as major bleeding compared with the general population. The goal of this review is to provide a summary of current evidence for the prevention and treatment of cancer-associated VTE. Validated risk prediction models are available to aide clinicians in identifying patients with cancer with the highest risk of VTE. Those patients with intermediate to high risk of VTE may benefit from primary prophylaxis with apixaban or rivaroxaban. Low-molecular-weight heparin is superior to vitamin K antagonists for the treatment of cancer-associated VTE. There is mounting evidence to support use of the direct oral anticoagulants for VTE in patients with cancer. Decisions on type and duration of anticoagulation in patients with cancer, either for primary or secondary prevention, should be made on a case-by-case basis with taking into account the individual patient bleeding and thrombotic risk.