Venous thromboembolism prophylaxis and treatment in cancer: a consensus statement of major guidelines panels and call to action.
OBJECTIVE
Venous thromboembolism (VTE) is an increasingly frequent complication of cancer and its treatments, and is associated with worsened mortality and morbidity in patients with cancer.


METHODS
The Italian Association of Medical Oncology, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, the French National Federation of the League of Centers Against Cancer, and the European Society of Medical Oncology have recently published guidelines regarding VTE in patients with cancer. This review, authored by a working group of members from these panels, focuses on the methodology and areas of consensus and disagreement in the various clinical guidelines as well as directions for future research.


RESULTS
There is broad consensus regarding the importance of thromboprophylaxis in hospitalized patients with cancer, including prolonged prophylaxis in high-risk surgical patients. Prophylaxis is not currently recommended for ambulatory patients with cancer (with exceptions) or for central venous catheters. All of the panels agree that low molecular weight heparins are preferred for the long-term treatment of VTE in cancer. Areas that warrant further research include the benefit of prophylaxis in the ambulatory setting, the risk/benefit ratio of prophylaxis for hospitalized patients with cancer, an understanding of incidental VTE, and the impact of anticoagulation on survival.


CONCLUSIONS
We call for a sustained research effort to investigate the clinical issues identified here to reduce the burden of VTE and its consequences in patients with cancer.
Khorana
Alok A
AA
James P. Wilmot Cancer Center, and Department of Medicine, University of Rochester, Rochester, NY, USA. alok_khorana@URMC.rochester.edu
Streiff
Michael B
MB
Farge
Dominique
D
Mandala
Mario
M
Debourdeau
Philippe
P
Cajfinger
Francis
F
Marty
Michel
M
Falanga
Anna
A
Lyman
Gary H
GH
D000925:Anticoagulants / Q000627:therapeutic use*; D001364:Awareness; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008495:Medical Oncology / Q000592:standards; D009369:Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000592:standards*; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000523:psychology*
D000925:Anticoagulants