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Oncology - Venous Thromboembolism in Malignancy - Fast Facts | NEJM Resident 360
Malignancy is associated with a significantly increased risk of venous thromboembolism (VTE). This risk is particularly elevated in patients with certain cancers; those undergoing surgery, radiation, or chemotherapy; and metastatic disease. In addition, VTE in patients with malignancy is associated with lower survival rates than VTE in patients without cancer.
The following table shows the risk-assessment model for VTE in malignancy, based on the Khorana score:
(Source: Prophylaxis Against Venous Thromboembolism in Ambulatory Patients with Cancer. N Engl J Med 2014.)
VTE Prophylaxis
There is increasing evidence that direct oral anticoagulants (DOACs) are equivalent to low-molecular-weight heparin (LMWH) in preventing recurrent VTE in cancer patients. Current guidelines suggest that either LMWH or DOACs may be used to treat cancer-associated thrombosis. However, the use of LMWH remains preferred over DOACs in patients with gastrointestinal malignancies due to a higher risk of bleeding with DOACs.
For management of VTE in patients with contraindications to anticoagulation and for information on inferior vena cava (IVC) filter use, see the Venous Thromboembolism section in the Hematology rotation guide.