Venous and Arterial Thromboembolism in Patients With Cancer
| Autor: | Lorenzo Gervaso, Alok A. Khorana, Heloni M. Dave |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
risk assessment models
KS Khorana score Deep vein VTE venous thromboembolism VVT visceral vein thrombosis Medicine Myocardial infarction Stroke ATE arterial thromboembolism education.field_of_study ASCO American Society of Clinical Oncology treatment cancer-associated thrombosis MM multiple myeloma CRNMB clinically relevant nonmajor bleeding Heparin GI gastrointestinal Thrombosis CAT cancer-associated thrombosis Pulmonary embolism medicine.anatomical_structure Oncology DVT deep venous thrombosis MI myocardial infarction prophylaxis Cardiology and Cardiovascular Medicine SPE segmental pulmonary embolism medicine.drug UHF unfractionated heparin medicine.medical_specialty ESMO European Society of Medical Oncology ICH intracranial hemorrhage ASH American Society of Hematology Population venous thromboembolism SSC Scientific and Standardization Committee AT antithrombin CVA cerebrovascular event arterial thromboembolism SSPE subsegmental pulmonary embolism education Intensive care medicine LMWH low-molecular-weight heparin ISTH International Society on Thrombosis and Haemostasis DOAC direct oral anticoagulant RAM risk assessment model business.industry Cancer VKA vitamin K antagonist medicine.disease HR hazard ratio PPV positive predictive value CI confidence interval State-of-the-Art Review PE pulmonary embolism NNT number needed to treat business |
| Zdroj: | JACC: CardioOncology |
| ISSN: | 2666-0873 |
| Popis: | Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a major cause of morbidity and mortality in patients with cancer. Arterial thromboembolism, including myocardial infarction and stroke, is also prevalent. Risk differs in subgroups, with higher rates observed in specific cancers including pancreas, stomach, and multiple myeloma. Thromboprophylaxis is recommended for most patients with active cancer hospitalized for medical illnesses and after major cancer surgery. Outpatient thromboprophylaxis is not routinely recommended, but emerging data suggest that a high-risk population that benefits from pharmacological thromboprophylaxis can be identified using a validated risk tool. Direct oral anticoagulants are emerging as the preferred new option for the treatment of cancer-associated VTE, although low-molecular-weight heparin remains a standard for patients at high bleeding risk. Management of VTE beyond the first 6 months and challenging clinical situations including intracranial metastases and thrombocytopenia require careful management in balancing the benefits and risks of anticoagulation and remain major knowledge gaps in evidence. Central Illustration Highlights • Patients with cancer are at increased risk of VTE and ATE, with significant consequences including mortality. • RAMs combining clinical and biochemical parameters can identify high-risk patients. • Thromboprophylaxis should be considered for patients identified as high-risk for VTE. • DOACs are an emerging option for acute VTE treatment, although LMWH remains an acceptable standard. • There are limited data that address the management of ATE in patients with cancer. • A multidisciplinary approach with the oncologist and cardiologist is currently recommended. |
| Databáze: | OpenAIRE |
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