Vaskulárna medicína 1/2022

Prevention of venous thromboembolism in high-risk oncological patients: what is specific?

Venous thromboembolism (VTE) is a common complication among patients with cancer and is one of the most common causes of increased morbidity and mortality. The risk factors for VTE are multifactorial and include cancer itself, chemotherapeutic agents, and patient-specific characteristics. The VTE prophylaxis in patients with cancer is challenging due to an increased risk of bleeding and VTE recurrence. The routine use of pharmacological thromboprophylaxis in all patients with cancer is not recommended. This is mainly due to the relatively low risk of VTE in ambulatory cancer patients and the increased risk of bleeding due to anticoagulants. The use of validated VTE risk prediction tools such as the Khorana score can help identify patients with cancer receiving chemotherapy who are at greater risk for VTE. Thus, the current guidelines recommend the use of low molecular weight heparin, possibly rivaroxaban or apixaban in patients at intermediate-to high-risk of VTE, identified by Khorana score ≥ 2 in the absence of active bleeding or not at high-risk of bleeding. However, the use of direct oral anticoagulants in the indication of primary thromboprophylaxis in medical or oncological patients has not yet been approved in our country.

Keywords: venous thromboembolism, thromboprophylaxis, Khorana score, low molecular weight heparins, direct oral anticoagulants