Key result
Medical thromboprophylaxis with LMWH or DOACs effectively prevents VTE in high-risk ambulatory cancer patients.
Why the study?
Despite recommendations, medical thromboprophylaxis is infrequently used in ambulatory cancer patients due to treatment burden and bleeding concerns, though risk assessment scores and evidence for anticoagulants now exist.
Does primary medical thromboprophylaxis prevent venous thromboembolism in patients with cancer?
Does primary medical thromboprophylaxis prevent venous thromboembolism in patients with cancer?
This review highlights the efficacy of LMWH and DOACs for primary VTE prophylaxis in high-risk ambulatory cancer patients, emphasizing the use of risk assessment models like the Khorana score to balance thrombotic and bleeding risks.
May support prophylaxis in high-risk ambulatory cancer patients; leaves open optimal agent, duration, and bleeding stratification.
Over the past two decades, the incidence of cancer-associated thrombosis (CAT) has increased. It is nowadays a common and often serious complication among patients with cancer. Although medical thromboprophylaxis is recommended for most surgical and nonsurgical cancer patients, it has been infrequently used in ambulatory patients with cancer because of the burden of treatment and concerns about bleeding. However, various risk assessment scores are now available and randomized placebo-controlled trials have established the efficacy of low-molecular-weight heparin or the direct oral Xa inhibitors rivaroxaban and apixaban in ambulatory patients with cancer at high risk of venous thromboembolism (VTE). This review provides an overview of (1) primary thromboprophylaxis in the setting of hospitalized surgical and medical patients, (2) extended thromboprophylaxis after hospital discharge, (3) performance of risk assessment tools for CAT, and (4) primary thromboprophylaxis in ambulatory patients with cancer. The aim is to provide support to physicians in identifying ambulatory patients with cancer at high VTE risk who benefit most from medical thromboprophylaxis according to current recommendations from international guidelines.
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Hart et al. (2024) conducted a review in Cancer-associated thrombosis (CAT). Primary thromboprophylaxis (LMWH, DOACs) was evaluated. Medical thromboprophylaxis with low-molecular-weight heparin or direct oral Xa inhibitors is effective for primary prevention of venous thromboembolism in high-risk ambulatory patients with cancer.
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