Originally published as JCO Early Release 10.1200/JCO.2009.22.3214 on August 31 2009

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Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action

Alok A. Khorana, Michael B. Streiff, Dominique Farge, Mario Mandala, Philippe Debourdeau, Francis Cajfinger, Michel Marty, Anna Falanga, Gary H. Lyman

From the James P. Wilmot Cancer Center, and the Department of Medicine, University of Rochester, Rochester, NY; Johns Hopkins Medical Institutions, Baltimore, MD; Service de Médecine Interne et Pathologie Vasculaire and L'Institut National de la Santé et de la Recherche Médicale Unit U 976; Department of Oncology, Hôpital Saint-Louis, Assistance Publique Hopitaux de Paris, Denis Diderot Paris 7 University; Department of Medical Oncology (Pr Khayat), Hôpital de la Salpêtrière, Assistance Publique Hôpitaux de Paris, University Paris VI, Paris; Department of Oncology and Internal Medicine, Hôpital des Armées de Desgenettes, Lyon, France; Division of Medical Oncology and the Thrombosis and Hemostasis Center, Department of Hematology-Oncology, Ospedali Riuniti, Bergamo, Italy; and Duke University and the Duke Comprehensive Cancer Center, Durham, NC.

Corresponding author: Alok A. Khorana, MD, 601 Elmwood Ave, Box 704, Rochester, NY 14642; e-mail: alok_khorana{at}URMC.rochester.edu.

Purpose Venous thromboembolism (VTE) is an increasingly frequent complication of cancer and its treatments, and is associated with worsened mortality and morbidity in patients with cancer.

Design The Italian Association of Medical Oncology, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, the French National Federation of the League of Centers Against Cancer, and the European Society of Medical Oncology have recently published guidelines regarding VTE in patients with cancer. This review, authored by a working group of members from these panels, focuses on the methodology and areas of consensus and disagreement in the various clinical guidelines as well as directions for future research.

Results There is broad consensus regarding the importance of thromboprophylaxis in hospitalized patients with cancer, including prolonged prophylaxis in high-risk surgical patients. Prophylaxis is not currently recommended for ambulatory patients with cancer (with exceptions) or for central venous catheters. All of the panels agree that low molecular weight heparins are preferred for the long-term treatment of VTE in cancer. Areas that warrant further research include the benefit of prophylaxis in the ambulatory setting, the risk/benefit ratio of prophylaxis for hospitalized patients with cancer, an understanding of incidental VTE, and the impact of anticoagulation on survival.

Conclusion We call for a sustained research effort to investigate the clinical issues identified here to reduce the burden of VTE and its consequences in patients with cancer.

A.F. and G.H.L. are co-senior authors of this article.

Supported by Grant No. 5K23CA120587-03 from the National Cancer Institute, Grant No. 1R01HL095109-01the National Heart, Lung and Blood Institute, and the V Foundation (A.A.K.); Grant No. 29/07 Oncological Research from the Italian Ministry of Health (A.F.); and by Grant No. 1R01HL095109-01 from the National Heart, Lung and Blood Institute (G.H.L.).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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