Venous thromboembolism in cancer patients – Risk scores and recent randomised controlled trials

Johannes Thaler; Cihan Ay; Ingrid Pabinger

doi:10.1160/TH12-04-0241

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2012; 108(06): 1042-1048
DOI: 10.1160/TH12-04-0241

Theme Issue Article

Schattauer GmbH

Venous thromboembolism in cancer patients – Risk scores and recent randomised controlled trials

Autor*innen

Johannes Thaler

¹Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria

²Comprehensive Cancer Center Vienna, Medical University of Vienna –Vienna General Hospital, Vienna, Austria
Cihan Ay

¹Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria

²Comprehensive Cancer Center Vienna, Medical University of Vienna –Vienna General Hospital, Vienna, Austria
Ingrid Pabinger

¹Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria

²Comprehensive Cancer Center Vienna, Medical University of Vienna –Vienna General Hospital, Vienna, Austria

Abstract

Summary

Cancer patients are at increased risk of developing venous thromboembolism (VTE). Guidelines recommend routine thromboprophylaxis in hospitalised acutely ill cancer patients and in myeloma patients receiving combination treatments including thalidomide or lenalidomide. Currently, thromboprophylaxis is not recommended in cancer out-patients. It is the aim of this review to give an overview of studies that applied scores for the risk assessment of cancer-related VTE. We will also discuss randomised controlled trials (RCTs) that investigated primary thromboprophylaxis in cancer patients. Recently, Khorana et al. published a practical and reproducible risk assessment score that includes clinical and laboratory parameters for the stratification of cancer patients according to their propensity to develop VTE. Patients assigned to the high-risk group are likely to benefit most from primary thromboprophylaxis. This score was validated in prospective and retrospective observational studies. In the Vienna Cancer and Thrombosis Study (CATS) the score was expanded by adding two biomarkers, and the prediction of VTE was considerably improved. In recent RCTs including cancer patients with different malignancies it was shown that thromboprophylaxis is safe and effective. However, VTE incidence rates were low. To date, no data is available from interventional studies applying thromboprophylaxis in cancer patients categorised into high-risk groups on the basis of risk assessment with scores. From the available literature we conclude that risk assessment for VTE is feasible in cancer patients;however, interventional studies to investigate the safety and efficacy of thromboprophylaxis in a high risk cancer population have yet to be performed.

Keywords

Cancer - venous thrombosis - risk assessment - randomised controlled trials

Volltext

Referenzen

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