Abstract
Venous thromboembolism (VTE), comprising deep-vein thrombosis and pulmonary embolism, is a frequent complication in ambulatory cancer patients. Despite the high risk, routine thromboprophylaxis is not recommended because of the high number needed to treat and the risk of bleeding. Two recent trials demonstrated that the number needed to treat can be reduced by selecting cancer patients at high risk for VTE with prediction scores, leading the latest guidelines to suggest such an approach in clinical practice. Yet, the interpretation of these trial results and the translation of the guideline recommendations to clinical practice may be less straightforward. In this clinically-oriented review, some of the controversies are addressed by focusing on the burden of VTE in cancer patients, discussing the performance of available risk assessment scores, and summarizing the findings of recent trials. This overview can help oncologists, hematologists, and vascular medicine specialists decide about thromboprophylaxis in ambulatory cancer patients.
Highlights
Background and AimVenous thromboembolism (VTE), comprising deep-vein thrombosis and pulmonary embolism, is a frequent complication in cancer patients
647 (38%) of those who did not develop VTE (HR 3.0, 95% CI 2.4–3.8). These studies showed that VTE is strongly correlated with mortality in cancer patients, it is unlikely that this association is causal
Given the corresponding substantial number needed to treat (NNT) of 30 patients to prevent one VTE as well as the increased tendency for major bleeding with thromboprophylaxis (RR, 1.4; 95% CI, 0.98–2.1), the authors concluded that more data were needed before implementation of routine primary thromboprophylaxis in ambulatory cancer patients could be justified
Summary
Venous thromboembolism (VTE), comprising deep-vein thrombosis and pulmonary embolism, is a frequent complication in cancer patients. Routine thromboprophylaxis for all ambulatory cancer patients is not recommended [5,6]. The interpretation of these trial results and the translation of the guideline recommendations to clinical practice may be less straightforward. In this clinically-oriented review, we will address some of the controversies to help oncologists, hematologists, and vascular medicine specialists in making decisions about thromboprophylaxis in ambulatory cancer patients. We will focus on the burden of VTE in cancer patients, discuss several of the available risk scores, summarize the findings of recent trials, and provide potential directions for future research
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