Primary Prevention of Cancer-Associated Thrombosis: Current Perspectives

Abstract

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.

Zusammenfassung

In den letzten zwei Jahrzenten wird eine Zunahme der Inzidenz von venösen Thromboembolien (VTE) bei Patienten mit Tumorerkrankung beobachtet. Patienten mit Krebserkrankung weisen neben dem Thromboserisiko ein erhöhtes Risiko für Blutungen auf. Während die medikamentöse Thromboseprophylaxe bei an Krebs erkrankten Patienten nach größeren tumorchirurgischen Eingriffen etabliert ist und bei hospitalisierten Tumorpatienten mit akut internistischen Erkrankungen und Immobilisierung empfohlen wird, stellt die Frage nach primärer Thromboseprophylaxe bei ambulanten Tumorpatienten weiterhin eine klinische Herausforderung dar. Mittlerweile stehen eine Vielzahl an VTE-Risikovorhersagemodellen zur Verfügung, die eine objektive Einschätzung des individuellen VTE-Risikos ermöglichen mit dem Ziel, Patienten mit hohem Risiko zu identifizieren, die von einer medikamentösen Thromboseprophylaxe profitieren. In den letzten Jahren wurden bei Patienten mit hohem VTE-Risiko Studien durchgeführt, die niedermolekulares Heparin bzw. die oralen Xa-Inhibitoren Apixaban und Rivaroxaban gegenüber Placebo verglichen haben.

Dieser Artikel gibt einen Überblick über aktuelle Empfehlungen zur medikamentösen Thromboseprophylaxe nach größeren operativen Eingriffen sowie bei hospitalisierten internistisch kranken Tumorpatienten. Der Fokus des Artikels liegt auf der Primärprophylaxe bei ambulanten Tumorpatienten. Anhand von VTE-Risikovorhersagemodellen sowie den Empfehlungen aus aktuellen Leitlinien wird dargestellt, welche ambulanten Tumorpatienten von einer Thromboseprophylaxe profitieren und wie diese durchgeführt werden kann.

Keywords

cancer - thrombosis - prophylaxis - ambulatory patients - anticoagulants

Schlüsselwörter

Tumorerkrankung - Thrombose - Thromboseprophylaxe - ambulante Krebspatienten - Antikoagulanzien

Authors' Contributions

C.H. and M.V. wrote the manuscript. All authors contributed to the manuscript drafting, reviewed the manuscript, and approved the final version.

Publication History

Received: 19 June 2024

Accepted: 26 July 2024

Article published online:
10 October 2024

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