Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

被引：1075

作者：

Key, Nigel S. ^{[1
]}

Khorana, Alok A. ^{[2
]}

Kuderer, Nicole M. ^{[3
,4
]}

Bohlke, Kari ^{[5
]}

Lee, Agnes Y. Y. ^{[6
]}

Arcelus, Juan, I ^{[7
]}

Wong, Sandra L. ^{[8
]}

Balaban, Edward P. ^{[9
]}

Flowers, Christopher R. ^{[10
]}

Francis, Charles W. ^{[11
,12
]}

Gates, Leigh E.

Kakkar, Ajay K. ^{[13
,14
]}

Levine, Mark N. ^{[15
]}

Liebman, Howard A. ^{[16
,17
]}

Tempero, Margaret A. ^{[18
]}

Lyman, Gary H. ^{[4
,19
]}

Falanga, Anna ^{[20
,21
]}

机构：

[1] Univ N Carolina, Chapel Hill, NC 27515 USA

[2] Cleveland Clin, Cleveland, OH 44106 USA

[3] Adv Canc Res Grp, Seattle, WA USA

[4] Univ Washington, Seattle, WA 98195 USA

[5] Amer Soc Clin Oncol, 2318 Mill Rd,Suite 800, Alexandria, VA 22314 USA

[6] BC Canc Agcy, Vancouver, BC, Canada

[7] Univ Granada, Granada, Spain

[8] Dartmouth Hitchcock Med Ctr, Lebanon, NH 03766 USA

[9] Penn State Canc Inst, Hershey, PA USA

[10] Emory Univ, Atlanta, GA 30322 USA

[11] James P Wilmot Canc Ctr, Rochester, NY USA

[12] Univ Rochester, Rochester, NY USA

[13] Thrombosis Res Inst, London, England

[14] UCL, London, England

[15] McMaster Univ, Hamilton, ON, Canada

[16] Univ Southern Calif, Los Angeles, CA 90007 USA

[17] Norris Comprehens Canc Ctr, Los Angeles, CA 90007 USA

[18] Univ Calif San Francisco, San Francisco, CA 94143 USA

[19] Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA

[20] Hosp Papa Giovanni XXIII, Bergamo, Italy

[21] Univ Milano Bicocca, Milan, Italy

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2020年 / 38卷 / 05期

关键词：

MOLECULAR-WEIGHT-HEPARIN; ADVANCED PANCREATIC-CANCER; DIRECT ORAL ANTICOAGULANTS; PATIENTS RECEIVING CHEMOTHERAPY; DEEP-VEIN THROMBOSIS; VENA-CAVA FILTERS; AMERICAN SOCIETY; AMBULATORY PATIENTS; RISK-ASSESSMENT; LUNG-CANCER;

D O I：

10.1200/JCO.19.01461

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

PURPOSE To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. METHODS PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommendations as needed. RESULTS The systematic review included 35 publications on VTE prophylaxis and treatment and 18 publications on VTE risk assessment. Two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in patients with cancer reported that edoxaban and rivaroxaban are effective but are linked with a higher risk of bleeding compared with low-molecular-weight heparin (LMWH) in patients with GI and potentially genitourinary cancers. Two additional RCTs reported on DOACs for thromboprophylaxis in ambulatory patients with cancer at increased risk of VTE. RECOMMENDATIONS Changes to previous recommendations: Clinicians may offer thromboprophylaxis with apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban and edoxaban have been added as options for VTE treatment; patients with brain metastases are now addressed in the VTE treatment section; and the recommendation regarding long-term postoperative LMWH has been expanded. Re-affirmed recommendations: Most hospitalized patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE. (C) 2019 by American Society of Clinical Oncology

引用

页码：496 / 520

页数：27

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