Update on Guidelines for the Prevention of Cancer-Associated Thrombosis

Authors:
Amro Elshoury Western New York BloodCare (formerly Hemophilia Center of WNY)
University at Buffalo, Buffalo, New York

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 MBBCh
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Jordan K. Schaefer Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

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Ming Y. Lim Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah

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Deidre P. Skalla Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, New York

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Michael B. Streiff Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland

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Volume/Issue:
Volume 20: Issue 13
Online Publication Date:
21 Jun 2022
DOI:
https://doi.org/10.6004/jnccn.2021.7108
Restricted access

Patients with cancer are at high risk of developing arterial and venous thromboembolism (VTE). They constitute 15% to 20% of the patients diagnosed with VTE. Depending on the type of tumor, cancer therapy, and presence of other risk factors, 1% to 25% of patients with cancer will develop thrombosis. The decision to start patients with cancer on primary thromboprophylaxis depends on patient preference, balancing risk of bleeding versus risk of thrombosis, cost, and adequate organ function. Currently, guidelines recommend against the use of routine primary thromboprophylaxis in unselected ambulatory patients with cancer. Validated risk assessment models can accurately identify patients at highest risk for cancer-associated thrombosis (CAT). This review summarizes the recently updated NCCN Guidelines for CAT primary prophylaxis, with a primarily focus on VTE prevention. Two main clinical questions that providers commonly encounter will also be addressed: which patients with cancer should receive primary thromboprophylaxis (both surgical and medical oncology patients) and how to safely choose between different anticoagulation agents.

Submitted May 29, 2021; final revision received October 24, 2021; accepted for publication October 27, 2021. Published online June 21, 2022.

Disclosures: Dr. Streiff has disclosed serving as a consultant for Pfizer and Janssen, and serving on the advisory board for Pfizer. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.

Correspondence: Amro Elshoury, MBBCh, Western New York BloodCare (formerly Hemophilia Center of WNY) and University at Buffalo, 1010 Main Street, Suite 300, Buffalo, NY 14202. Email: aelshoury@wnybloodcare.org
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
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Copyright:
Copyright © 2022 by the National Comprehensive Cancer Network 2022
Article Category:
Review Article
Received:
29 May 2021
Accepted:
27 Oct 2021
Print Publication Date:
01 Dec 2022
Online Publication Date:
21 Jun 2022

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