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This article from the NEJM meta-Journal (NEJM Journal Watch) Venous Thromboembolism in Cancer Patients: Treatment Guideline Update venous thromboembolism in cancer patients: a review of the guideline update: Brady L.
Stein, MD, MHS American Society of Hematology released cancer-related thrombosis Treatment guidelines.
Organizer: American Society of Hematology (ASH).
Background and purpose Venous thromboembolism (VTE) occurs frequently in patients with solid tumors and hematological malignancies, and increases the morbidity and mortality of patients.
Standard treatment options include low-molecular-weight heparin (LMWH) and oral direct anticoagulant (DOAC), but cancer patients have a higher bleeding rate than VTE patients who do not have cancer, making their treatment more complicated.
The expert committee convened by ASH released the latest recommendations on the prevention and treatment of VTE for cancer patients.
Key Points For patients who have received systemic treatment and are judged to be at high (rather than low or moderate) risk of thrombosis, it is recommended that DOAC be used for primary prevention.
In addition, for patients with multiple myeloma receiving immunomodulatory drugs, low-dose aspirin, fixed low-dose vitamin K antagonists or LMWH are recommended.
For patients in the recovery period after abdominal/pelvic surgery, primary prevention of VTE is recommended, but there is no such recommendation for patients who have been hospitalized for reasons other than surgery.
The initial treatment options for cancer-related VTE include DOAC or LMWH; for accidentally diagnosed pulmonary embolism (PE), even if it is a subsegmental pulmonary embolism, the above-mentioned options are also recommended, rather than just observation.
For patients with active malignancies, it is proposed to extend the anticoagulation time.
For patients who still have VTE recurrence after receiving a therapeutic dose of enoxaparin, it is recommended to increase LMWH to a super-therapeutic level or continue to use the same dose.
Comments Given the complexity of the treatment of cancer-related VTE, the publication of the guidelines is gratifying, but unfortunately, all these recommendations are conditional rather than strongly recommended.
The guidelines deal with common conditions in clinical practice, including accidental pulmonary embolism, which recommends anticoagulation therapy.
If the central venous catheter is functioning normally, it should be left in place and not taken out in the event of a deep vein thrombosis of the upper extremity.
A very unfortunate common situation is that VTE still recurs when the patient is receiving anticoagulation at a therapeutic dose.
We do not yet know which of the following options can improve the outcome: increase the dose, continue to use the same dose, or switch to another drug.
Finally, although it is recommended to take primary preventive measures for cancer patients at high risk of thrombosis, it is not clear whether this practice is widespread in routine clinical practice.
Commented article Lyman GH et al.
American Society of Hematology 2021 guidelines for management of venous thromboembolism: Prevention and treatment in patients with cancer.
Blood Adv 2021 Feb 23; 5:927.
(https://doi.
org/10.
1182/bloodadvances .
2020003442) Related reading NEJM Journal Watch The NEJM Journal Watch is published by the NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers in Medicine" jointly created by Jiahui Medical Research and Education Group (JMRE) and "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
Stein, MD, MHS American Society of Hematology released cancer-related thrombosis Treatment guidelines.
Organizer: American Society of Hematology (ASH).
Background and purpose Venous thromboembolism (VTE) occurs frequently in patients with solid tumors and hematological malignancies, and increases the morbidity and mortality of patients.
Standard treatment options include low-molecular-weight heparin (LMWH) and oral direct anticoagulant (DOAC), but cancer patients have a higher bleeding rate than VTE patients who do not have cancer, making their treatment more complicated.
The expert committee convened by ASH released the latest recommendations on the prevention and treatment of VTE for cancer patients.
Key Points For patients who have received systemic treatment and are judged to be at high (rather than low or moderate) risk of thrombosis, it is recommended that DOAC be used for primary prevention.
In addition, for patients with multiple myeloma receiving immunomodulatory drugs, low-dose aspirin, fixed low-dose vitamin K antagonists or LMWH are recommended.
For patients in the recovery period after abdominal/pelvic surgery, primary prevention of VTE is recommended, but there is no such recommendation for patients who have been hospitalized for reasons other than surgery.
The initial treatment options for cancer-related VTE include DOAC or LMWH; for accidentally diagnosed pulmonary embolism (PE), even if it is a subsegmental pulmonary embolism, the above-mentioned options are also recommended, rather than just observation.
For patients with active malignancies, it is proposed to extend the anticoagulation time.
For patients who still have VTE recurrence after receiving a therapeutic dose of enoxaparin, it is recommended to increase LMWH to a super-therapeutic level or continue to use the same dose.
Comments Given the complexity of the treatment of cancer-related VTE, the publication of the guidelines is gratifying, but unfortunately, all these recommendations are conditional rather than strongly recommended.
The guidelines deal with common conditions in clinical practice, including accidental pulmonary embolism, which recommends anticoagulation therapy.
If the central venous catheter is functioning normally, it should be left in place and not taken out in the event of a deep vein thrombosis of the upper extremity.
A very unfortunate common situation is that VTE still recurs when the patient is receiving anticoagulation at a therapeutic dose.
We do not yet know which of the following options can improve the outcome: increase the dose, continue to use the same dose, or switch to another drug.
Finally, although it is recommended to take primary preventive measures for cancer patients at high risk of thrombosis, it is not clear whether this practice is widespread in routine clinical practice.
Commented article Lyman GH et al.
American Society of Hematology 2021 guidelines for management of venous thromboembolism: Prevention and treatment in patients with cancer.
Blood Adv 2021 Feb 23; 5:927.
(https://doi.
org/10.
1182/bloodadvances .
2020003442) Related reading NEJM Journal Watch The NEJM Journal Watch is published by the NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers in Medicine" jointly created by Jiahui Medical Research and Education Group (JMRE) and "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
