Asia-Pacific Journal of Oncology

Review Article | Open Access

Navigating in the labyrinth of thrombotic and bleeding risks in patients with malignancies – how to make the most reasonable choices for personalized anticoagulation?

Katarzyna (Kate) Rygiel1

1Department of Family Practice, Medical University of Silesia (SUM), Zabrze, Poland.
Correspondence: Katarzyna (Kate) Rygiel (Department of Family Practice, Medical University of Silesia (SUM), 3 Maja St, 41-800 Zabrze, Poland ; E-mail: kasiaalpha@yahoo.co.uk).

Asia-Pacific Journal of Oncology 2020, 1: 68-76. https://doi.org/10.32948/ajo.2020.12.31

Received: 23 Dec 2020 | Accepted: 31 Dec 2020 | Published online: 31 Dec 2020

Abstract

Venous thromboembolism (VTE) frequently occurs among patients with malignancies and poses an important cause of morbidity and mortality in this population. Therefore, effective and safe thromboprophylaxis for oncology patients at the increased risk of VTE is of utmost importance. Commonly used anticancer treatments, including hormonal therapy (HT), chemotherapy (CHT), targeted therapy (TT), immune therapy (IT), radiotherapy (RT), and anti-angiogenesis monoclonal antibodies, as well as surgical procedures have been associated with VTE. For this reason, risk stratification scores, including tumor site, laboratory parameters, and patient’s clinical characteristics can help most accurately identify those patients, who will take the greatest advantage of a personalized approach to VTE.
This mini-review discusses cancer-related VTE risk stratification scores (e.g., the Khorana, Vienna Cancer and Thrombosis (CATS), and PROTECHT) that have been very useful for the detection of patients at the highest risk of VTE, who require an individual choice of the anticoagulant. This article briefly summarizes the updated American Society of Clinical Oncology (ASCO) clinical guidelines for the prevention and treatment of VTE in patients with cancer. In particular, it presents the direct oral anticoagulants (DOACs) as a new opportunity for both the preventive and therapeutic approach to VTE in this population. Furthermore, this overview provides some practical implications of the ASCO recommendations to the decision-making regarding safe and effective, personalized anticoagulant selection in various clinical setting. Hopefully, blending the patient’s medical context and personal preferences into VTE risk stratification scores will contribute to progress in the management of cancer-related VTE.

Key words Venous thromboembolism (VTE); non-vitamin K antagonist oral anticoagulants (NOACs), direct oral anticoagulants (DOACs), VTE risk stratification scores, Khorana Score (KS), cancer-related VTE