Key result
Prophylactic DOACs cut VTE risk ~44% vs placebo in ambulatory cancer patients.
Why the study?
Venous thromboembolism is a common complication in ambulatory cancer patients receiving anticancer therapies, prompting the need to summarize evidence on risk assessment and primary thromboprophylaxis.
Does primary thromboprophylaxis reduce venous thromboembolism in ambulatory cancer patients?
Does primary thromboprophylaxis reduce venous thromboembolism in ambulatory cancer patients?
Effect estimate: RR 0.56 (95% CI 0.38-0.83)
Risk assessment models like the Khorana score can identify ambulatory cancer patients at high risk for VTE who may benefit from primary thromboprophylaxis with DOACs or LMWH, balancing VTE reduction against bleeding risks.
May support DOAC thromboprophylaxis in high-risk ambulatory cancer patients; leaves open bleeding risk stratification and optimal duration.
Venous thromboembolism (VTE) is a common complication in ambulatory cancer patients receiving anticancer therapies. Many patient-, cancer-, and treatment‑related factors along with specific biomarkers can be associated with an increased risk of VTE in patients with cancer. Risk assessment models, such as the Khorana score, serve as valuable tools to aid in the identification of patients with cancer who are at high risk of VTE. Two randomized controlled trials have evaluated the efficacy of primary thromboprophylaxis with low‑dose direct oral anticoagulants, apixaban and rivaroxaban, to reduce the risk of VTE in ambulatory patients with cancer who are at intermediate to high risk of VTE identified by the Khorana score. This narrative review summarizes the literature on the risk factors and risk assessment process for VTE, and the use of primary thromboprophylaxis in ambulatory cancer patients. We also outline important practical considerations for initiating primary thromboprophylaxis in this population.
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Harrigan et al. (2024) conducted a review in Cancer-associated thrombosis. Primary thromboprophylaxis (DOACs or LMWH) vs. Placebo or observation was evaluated on Venous thromboembolism (VTE) (RR 0.56, 95% CI 0.38-0.83). Primary thromboprophylaxis with direct oral anticoagulants reduced the relative risk of venous thromboembolism by 44% (RR 0.56) compared to placebo in ambulatory cancer patients.
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