Key result
Thromboprophylaxis with low molecular weight heparin reduces the rate of symptomatic VTE by about one half in ambulatory cancer patients, resulting in a number needed to treat of 40 to 50.
Why the study?
Advances in VTE risk stratification and growing evidence for DOACs have led to a reconsideration of the risk-benefit assessment of thromboprophylaxis in ambulatory cancer patients.
Does thromboprophylaxis with DOACs or LMWH prevent venous thromboembolism in ambulatory patients with cancer?
Does thromboprophylaxis with DOACs or LMWH prevent venous thromboembolism in ambulatory patients with cancer?
This narrative review summarizes recent evidence from randomized trials on the efficacy and safety of DOACs for VTE prophylaxis in ambulatory cancer patients, aiming to update risk-benefit assessments.
Supports LMWH thromboprophylaxis in ambulatory cancer patients on chemotherapy; reinforces landmark trial reductions in CAT risk.
Venous thromboembolism (VTE) is frequent among patients with cancer. Ambulatory cancer patients starting chemotherapy have a 5% to 10% risk of cancer associated thrombosis (CAT) within the first year after cancer diagnosis. This risk may vary according to patient characteristics, cancer location, cancer stage, or the type of chemotherapeutic regimen. Landmark studies evaluating thrombophrophylaxis with low molecular weight heparin (LMWH) for ambulatory cancer patients have shown a relative reduction in the rate of symptomatic VTE of about one half. However, the absolute risk reduction is modest among unselected patients given a rather low risk of events resulting in a number needed to treat (NNT) of 40 to 50. Moreover, this modest benefit is mitigated by a trend towards an increased risk of bleeding, and the economic and patient burden due to daily injections of LMWH. For these reasons, routine thromboprophylaxis is not recommended by expert societies. Advances in VTE risk stratification among cancer patients, and growing evidence regarding efficacy and safety of direct oral anticoagulants (DOACs) for the treatment and prevention of CAT have led to reconsider the paradigms of this risk-benefit assessment. This narrative review aims to summarize the recent evidence provided by randomized trials comparing DOACs to placebo in ambulatory cancer patients and its impact on expert recommendations and clinical practice.
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Rossel et al. (2020) conducted a review in Venous thromboembolism in ambulatory cancer patients. Thromboprophylaxis (LMWH and DOACs) vs. Placebo was evaluated. Thromboprophylaxis with low molecular weight heparin reduces the rate of symptomatic VTE by about one half in ambulatory cancer patients, resulting in a number needed to treat of 40 to 50.
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