Cancer increases the risk of venous thromboembolism

Cancer increases the risk of venous thromboembolism

Patients with cancer face an increased risk of venous thromboembolism (VTE) as malignancy is associated with a hypercoagulable state and the use of chemotherapy agents may also contribute to an increased risk. In fact, VTE is a significant cause of morbidity and mortality in patients with cancer. Risk factors for cancer-associated VTE include: tumor type; age; stage of cancer; and VTE history. Risk stratification and use of biomarker-based approaches may assist in the provision of targeted thromboprophylaxis. The use of a validated predictive model for VTE risk in patients with cancer receiving chemotherapy may also enable clinicians to determine whether patients are at particularly high risk of VTE.

Preventing AF-related stroke: a healthcare imperative

Treatments intended to restore normal sinus rhythm do not necessarily reduce the risk of stroke in patients with atrial fibrillation (AF). Therefore, even for patients who have undergone successful cardioversion, lifelong anticoagulation is appropriate when the risk of stroke or recurrent AF is high. Various guidelines exist for the management of patients with AF, including: ACCP 2012, ACCF/AHA/HRS 2011, and ESC 2012. The guidelines recommend the use of antithrombotic therapy for stroke prevention in patients with AF based on an individual’s predicted risk of stroke.

Treatment of DVT and PE

Prompt diagnosis and treatment of deep vein thrombosis (DVT) is essential to decrease both the risk of recurrence and a potentially fatal pulmonary embolism (PE). Traditionally, initial treatment of DVT and PE begins with a parenteral anticoagulant, transitioning to longer-term Vitamin K antagonist (VKA) therapy. Another option is the direct Factor Xa inhibitor rivaroxaban, an oral anticoagulant. This single-drug approach removes the need for overlapping administration of heparin and a VKA, which can be complex owing to the requirement for coagulation monitoring and dose-adjustment of the VKA. The use of compression stockings is an important adjunct to pharmacological treatment in patients with DVT. Other venous thromboembolism (VTE) treatment approaches may include: surgery; catheter-guided thrombectomy; or thrombolytic therapy.

Expanding Real-Life Knowledge

Registries that record real-world patient outcomes serve many important functions, identifying unmet patient needs and verifying the safety and efficacy of newly introduced therapies. This verification role is important as outcomes in clinical trials may not always reflect what is achieved in practice. Over the past two decades, several major medical registries have been launched across many therapy areas in which anticoagulant therapy is used, including: secondary prevention of acute coronary syndrome (ACS); stroke prevention in patients with atrial fibrillation (AF); and prevention and treatment of venous thromboembolism (VTE).

Venous thromboembolism prevention in patients with cancer

Low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH) have been shown to have similar efficacy for thromboprophylaxis in patients with cancer. Both agents are recommended by the 2012 ACCP guidelines for thromboprophylaxis in patients with cancer who are at increased risk of venous thromboembolism (VTE). Vitamin K antagonists (VKAs) and fondaparinux are two other options for the prevention of VTE in patients with cancer. Although some clinical studies have demonstrated a benefit for thromboprophylaxis in hospitalized and surgical patients with cancer, it is not routinely recommended for ambulatory cancer patients. Despite the guideline recommendations, adequate VTE prophylaxis is currently underused in patients with cancer.

Treatment of deep vein thrombosis and pulmonary embolism

Anticoagulant treatment in patients with cancer with venous thromboembolism (VTE) can be a challenge as treatment may often be interrupted by invasive procedures or thrombocytopenia caused by chemotherapy. Oral Vitamin K antagonists (VKAs) may not always be appropriate in patients with cancer; low-molecular-weight heparins (LMWHs), in addition to unfractionated heparin (UFH) and fondaparinux, may be an alternative to VKAs for certain patients. The risk of recurrent VTE is higher in patients with cancer than in those without and can depend on a number of factors including: the presence of metastatic cancer; treatment with chemotherapy; and the type of cancer.