Management of venous Thromboembolism in cancer: a brief review of risk-benefit approaches and guidelines' recommendations.
Patients with cancer are at substantial risk for morbidity and mortality from venous thromboembolism (VTE). However, the benefits of anticoagulant prophylaxis in preventing VTE morbidity and mortality have to be weighed against the risks of morbidity and mortality associated with major bleeding events. Risk-benefit analyses should take into account that the risk of VTE and risk of bleeding vary among cancer patients based on a number of factors, including patient characteristics and the causes of VTE. Current guidelines for VTE prophylaxis recommend that anticoagulant prophylaxis be considered for all hospitalized patients with cancer and do not recommend routine prophylaxis in ambulatory patients, except in particular high-risk settings. It is generally recommended that anticoagulant prophylaxis be considered for patients with cancer undergoing surgery, although the optimal postoperative duration of treatment remains unclear. Data on the appropriate duration of prophylaxis for recurrent VTE are limited to studies examining 3- or 6-month treatment courses, but guidelines recommend continuing treatment indefinitely in patients with active cancer. Much work remains to be done in designing and implementing strategies for assessing and reducing VTE risk in the oncology population. One issue is that appropriately managing VTE requires that busy clinicians keep in mind a vast number of potential variables exceeding the cognitive capacity of the average person. Hence, there is an urgent need to develop a clinical decision-support system that can help integrate benefits and risks as well as take into account patients' preferences and values in managing VTE.
Djulbegovic
Benjamin
B
Medicine and Oncology, University of South Florida, Tampa, FL 33612, USA. bdjulbeg@health.usf.edu
D006801:Humans; D009369:Neoplasms / Q000150:complications*; D011788:Quality of Life; D018570:Risk Assessment; D054556:Venous Thromboembolism / Q000209:etiology* / Q000628:therapy*