International Journal of Cancer and Oncology International Journal of Cancer and Oncology International Journal of Cancer and Oncology International Journal of Cancer and Oncology 2377-0902Ommega Online PublishersNew Jersey, USA269010.15436/2377-0902.20.2690Research ArticleAn Overview of Venous Thrombo-Embolism Prophylaxis in Ambulatory Cancer Patients An Overview of Venous Thrombo-Embolism Prophylaxis in Ambulatory Cancer Patients FirasKreidieh1Department of Internal Medicine American University of Beirut Medical Center Beirut ndash Lebanon2Naef K Basile Cancer Institute American University of Beirut Medical Center Beirut ndash Lebanon Authors contributed equallyEditor* E-mail: fk30@aub.edu.lb
The authors have declared that no competing interests exist.
20203006202071IJCO-20-RW-269015032020240620202020Creative Commons Attribution LicenseThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Introduction Patients with cancer are at higher risk of developing venous thrombo-embolism VTE with prevalence ranging between 15 and 20 1-3 While bedridden and or hospitalized cancer patients usually have standard prophylactic and therapeutic guidelines ambulatory patients who undergo chemotherapy hormonal therapy immunotherapy or radiotherapy do not have standard indications for prevention In this review article we aim at providing an overview of venous thrombo-embolic complications in ambulatory cancer patients unveiling the available VTE risk scores and options for prophylaxis Body There are several risk stratification scores that were studied for ambulatory cancer patients The modified Khorana score is currently recommended by the American Society of Clinical Oncology however this score was shown in some studies to perform poorly in some cancers like lung cancer 30 Patients with a solid tumor and risk score of ge 2 have an estimated risk of symptomatic thrombosis of 9 6 during the first 6 months of chemotherapy The role of LMWH DOACs and vitamin K antagonists for thromboprophylaxis in ambulatory cancer patients has been studied with varying results Both the European Society of Medical Oncology and the American Society of Medical Oncology do not recommend the routine use of thromboprophylaxis for ambulatory cancer patients The CASSINI and AVERT trials have shown that thromboprophylaxis with DOACs is relatively effective and safe in the population of cancer patients with Khorana score ge 2 However it may be safer to use them in patients with non-GI or GU cancers as it is consistently proven that DOACs are associated with increased risk of bleeding in these tumor types Both trials had different tumor types distribution and methodology thus affecting outcomes though subgroup analysis of pancreatic cancer patients in the CASSINI trial revealed no increased bleeding with rivaroxaban Conclusion Risk assessment using predictive scores to identify high risk ambulatory cancer patients and implementing thereafter a patient-centered approach is recommended Discussion with each patient the risks versus the benefits of thromboprophylaxis should be the basis of initiation of thromboprophylaxis Conducting randomizing trials assessing DOACs in individual cancer subtypes may be the best method to provide definitive evidence about their efficacy and safety 10