Preventative and curative treatment of venous thromboembolic disease in cancer patients

Cancer-associated venous thromboembolism (CAT) is common in patients with cancer and associated with significant morbidity and mortality. The incidence of CAT continues to rise, complicating patient care and burdening healthcare systems. Patients with cancer experiencing VTE face poorer prognoses, m...

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Published in:La Presse médicale (1983) 2024-12, Vol.53 (4), p.104242, Article 104242
Main Authors: Carrier, Marc, Bertoletti, Laurent, Girard, Philippe, Laporte, Sylvie, Mahé, Isabelle
Format: Article
Language:English
Subjects:
Anticoagulants
Anticoagulants - therapeutic use
Factor XIa inhibitors
Hemorrhage - chemically induced
Hemorrhage - etiology
Hemorrhage - prevention & control
Heparin
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Low molecular weight heparin
Neoplasms
Neoplasms - complications
Risk Assessment
Venous thromboembolism
Venous Thromboembolism - etiology
Venous Thromboembolism - prevention & control
Venous thrombosis
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Summary:Cancer-associated venous thromboembolism (CAT) is common in patients with cancer and associated with significant morbidity and mortality. The incidence of CAT continues to rise, complicating patient care and burdening healthcare systems. Patients with cancer experiencing VTE face poorer prognoses, making prevention and effective management imperative. This narrative review synthesizes evidence on thromboprophylaxis in ambulatory patients with cancer receiving systemic therapy and acute treatment strategies for CAT. Risk assessment models (e.g., Khorana score) aid in identifying high-risk patients who may benefit from thromboprophylaxis. Pharmacological thromboprophylaxis with low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) has been shown to reduce the risk of CAT without significantly increasing the risk of bleeding complications. However, implementation of risk-based strategies remains limited in clinical practice. For acute CAT management, LMWHs have been the standard of care, but DOACs are increasingly favored due to their convenience and efficacy. However, challenges persist, including bleeding risks and drug interactions. Emerging therapies targeting Factor XI inhibitors present promising alternatives, potentially addressing current limitations in anticoagulation management for CAT.
ISSN:0755-4982
2213-0276
2213-0276
DOI:10.1016/j.lpm.2024.104242