American Society of Clinical Oncology Guideline: Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer

Duke University, Durham, North Carolina, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 01/2008; 25(34):5490-505. DOI: 10.1200/JCO.2007.14.1283
Source: PubMed

ABSTRACT To develop guideline recommendations for the use of anticoagulation in the prevention and treatment of venous thromboembolism (VTE) in patients with cancer.
A comprehensive systematic review of the medical literature on the prevention and treatment of VTE in cancer patients was conducted and reviewed by a panel of content and methodology experts. Following discussion of the results, the panel drafted recommendations for the use of anticoagulation in patients with malignant disease.
The results of randomized controlled trials of primary and secondary VTE medical prophylaxis, surgical prophylaxis, VTE treatment, and the impact of anticoagulation on survival of patients with cancer were reviewed. Recommendations were developed on the prevention of VTE in hospitalized, ambulatory, and surgical cancer patients as well as patients with established VTE, and for use of anticoagulants in cancer patients without VTE to improve survival.
Recommendations of the American Society of Clinical Oncology VTE Guideline Panel include (1) all hospitalized cancer patients should be considered for VTE prophylaxis with anticoagulants in the absence of bleeding or other contraindications; (2) routine prophylaxis of ambulatory cancer patients with anticoagulation is not recommended, with the exception of patients receiving thalidomide or lenalidomide; (3) patients undergoing major surgery for malignant disease should be considered for pharmacologic thromboprophylaxis; (4) low molecular weight heparin represents the preferred agent for both the initial and continuing treatment of cancer patients with established VTE; and (5) the impact of anticoagulants on cancer patient survival requires additional study and cannot be recommended at present.

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    • "Internationally, several additional organizations have developed guidelines for patients with cancer at risk for VTE including the Italian Association of Medical Oncology, the European Society of Medical Oncology, and the French National Federation of the League of Centers Against Cancer [9- 11]. In 2007, the American Society of Clinical Oncology (ASCO) published evidence-based guidelines for the treatment and prevention of VTE in patients with cancer based on a systematic review of the literature [12] [13]. ASCO recently presented updated clinical practice guidelines on the treatment and prevention of VTE in patients with cancer following an extensive systematic review of the literature published since the original guidelines [14]. "
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    ABSTRACT: The association between cancer and thrombosis has been recognized for more than 150 years. Not only are patients with cancer at a substantially increased risk of developing venous thromboembolism (VTE), the link between several coagulation factors and tumor growth, invasion, and the development of metastases has been established. Reported rates of VTE in patients with cancer have increased in recent years likely reflecting, in part, improved diagnosis with sophisticated imaging techniques as well as the impact of more aggressive cancer diagnosis, staging, and treatment. Various therapeutic interventions, such as surgery, chemotherapy, hormonal therapy, targeted therapeutic strategies as well as the frequent use of indwelling catheters and other invasive procedures also place cancer patients at increased risk of VTE. The increasing risk of VTE, the multitude of risk factors, and the greater risk of VTE recurrence and death among patients with cancer represent considerable challenges in modern clinical oncology. The American Society of Clinical Oncology (ASCO) originally developed guidelines for VTE in patients with cancer in 2007. ASCO recently updated clinical practice guidelines on the treatment and prevention of VTE in patients with cancer following an extensive systematic review of the literature. Revised 2013 guidelines have now been presented and will be discussed in this review. Although several new studies were identified and considered, many important questions remain regarding the relationship between thrombosis and cancer and the optimal care of patients at risk for VTE. © 2014 Elsevier Ltd. All rights reserved.
    Thrombosis Research 05/2014; 133 Suppl 2:S122-7. DOI:10.1016/S0049-3848(14)50021-7 · 2.45 Impact Factor
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    • "A retrospective cohort study reports that the rate of VTE is 7.4% among patients with gastric cancers [5]. The American Society of Clinical Oncology VTE Guideline Panel recommends that physicians consider pharmacological thromboprophylaxis in patients undergoing major surgery for malignant disease [6]. Low-molecular-weight heparin (LMWH) has become a standard pharmacological agent for preventing VTE because it is easy to use, just once a day injection schedule. "
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    ABSTRACT: This study evaluated the efficacy for preventing venous thromboembolism (VTE) and adverse effects of low-molecular-weight heparin (LMWH) in order to launch a prospective clinical trial in Korea. We reviewed the medical records of 108 consecutive patients who underwent gastric cancer surgery. These patients were divided into 2 groups according to the type of thromboprophylaxis: group A, LMWH combined with intermittent pneumatic compression (IPC); group B, IPC alone. The postoperative outcomes of the two groups were compared. Symptomatic VTE was observed in only 1 patient (0.9%) from group B. Postoperative bleeding was more common in group A than in group B (10.9% vs. 7.5%), although the difference was not significant (P = 0.055). Most bleeding episodes were minor and managed conservatively without intervention. Only a high body mass index was associated with a significantly increased risk of postoperative bleeding (odds ratio, 1.45; 95% confidence interval, 1.12-2.43; P = 0.051). A 40 mg of enoxaparin sodium is a safe and feasible dose for prevention of VTE. With the results of this study, we are planning a prospective randomized clinical trial to investigate the clinical efficacy of LMWH thromboprophylaxis in gastric cancer patients in Korea.
    Annals of Surgical Treatment and Research 01/2014; 86(1):22-7. DOI:10.4174/astr.2014.86.1.22
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    • "Chemotherapy can increase the risk of thromboembolism by at least three mechanisms: (1) acute traumatic damage to the vessels wall; (2) non-acute toxic damage of the endothelium and (3) a decrease in natural anticoagulants; protein C, thrombomodulin, fibrinolysis and antithrombin III. The most recent guidelines from the American Society of Clinical Oncologists [26] state that further clinical trials are required before any recommendations can be made about the use of antithrombotic prophylaxis in ambulatory patients receiving chemotherapy for cancer. We identified high BMI 30 as an independent risk factor for VTE in multivariate analysis: this has also been reported by others [27] [28] [29]. "
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    ABSTRACT: Ovarian cancer has a higher incidence of venous thromboembolism (VTE) than other cancers. Clear cell cancers carry the highest risk at 11-27%. The aim of this study was to identify the predisposing factors for VTE in a population of ovarian cancer patients and to determine the influence of VTE on overall survival. VTE events were identified from hospital and general practice/community care records for all patients with ovarian cancer who were diagnosed and treated in a tertiary cancer center between 2006 and 2010. The overall incidence of VTE was 9.7% (33) in 344 patients. Sixteen (48%) had pulmonary embolism. Six (18%) presented with VTE. Five (15%) had VTE diagnosed during pre-treatment routine CT scanning. Eleven (33%) developed VTE following surgery and eleven (33%) developed VTE during chemotherapy. Risk factors associated with the occurrence of VTE were BMI≥30 (p<0.01), clear cell carcinoma (p<0.05), advanced stage (p<0.01), high grade (p<0.01) and CA125>500IU/ml (p<0.001). The occurrence of VTE was associated with decreased overall survival time (p<0.001). The incidence of VTE is high in ovarian cancer especially in the clear cell subtype. VTE adversely affects survival in ovarian cancer. Obesity, high grade and stage of cancer, clear cell subtype and high CA 125 level should be incorporated into protocols of VTE prophylaxis in women with ovarian cancer.
    European journal of obstetrics, gynecology, and reproductive biology 07/2013; DOI:10.1016/j.ejogrb.2013.06.004 · 1.70 Impact Factor
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