Prevention and treatment of cancer associated venous thromboembolism – interdisciplinary consensus

Czech version

Authors: Ivar Vacula ¹; Zuzana Rusiňáková ²; Denisa Čelovská ³; Peter Jackuliak ⁴; Ján Slopovský ⁵; Patrik Palacka ⁵; Matej Moščovič ⁶; Stanislav Špánik ⁷; Ján Staško ⁸; Alexander Wild ⁹; Angelika Bátorová ¹⁰; Juraj Ma Arič ¹¹
Authors‘ workplace: Angiologická‑interná ambulancia, Trnava ¹; Klinika onkohematológie LF UK a NOÚ, Bratislava ²; I. interná klinika LF UK a UN, Bratislava ³; V. interná klinika LF UK a UN, Bratislava ⁴; II. onkologická klinika LF UK a NOÚ, Bratislava ⁵; Klinika angiológie VÚSCH, a. s., Košice ⁶; I. onkologická klinika LF UK a OÚSA, Bratislava ⁷; Klinika hematológie a transfuziológie JLF UK Martin ⁸; Hematologické oddelenie, FNsP F. D. Roosevelta, Banská Bystrica ⁹; Klinika hematológie a transfúziológie LF UK, SZU a UN, Bratislava ¹⁰; Klinika angiológie LF UK a NÚSCH, a. s., Bratislava ¹¹
Published in: Vnitř Lék 2022; 68(4): 221-226
Category: Review Articles

Overview

The increasing volume of the data and experience with direct oral anticoagulants (DOACS) in the primary and secondary prevention of venous thromboembolism in oncologic patients (CAVTE) has recently lead to changes in several international guidelines. We reflect these changes within the conditions in Slovak republic. In the primary prevention of CAVTE we recognise oncosurgical patients and nonsurgical patients: hospitalised and out patients. Low molecular weight heparins are still dominant in the primary prevention of CAVTE. Regarding the treatment and the secondary prevention of CAVTE, we recommend always to consider the possibility to use DOACs as they proved to be non inferior to LMWH. However, LMWH should be prefered over DOACs as well as over warfarin (VKA) in all patients who are in a clinically unstable condition with the high risk of bleeding and/or interaction with the systemic treatment. Primarily in the patients with intraluminal tumours of the upper part of the gastrointestinal tract and genitourinary tumours with the high risk of bleeding. As for the lack of data, LMWH are still preferd also in patients with primary tumours and metastatic disease of the central nervous system and in hemato oncology.

Keywords:

low molecular weight heparin (LMWH) – bleeding – venous thromboembolism (VTE – CAVTE) – oncological disease – direct oral anticoagulant (DOAC)

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