Prevention and treatment of venous thromboembolism in patients with hematological neoplasms

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.