In an article published in The Lancet Oncology, Farge et al outlined the International Initiative on Thrombosis and Cancer (ITAC) 2022 clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism (VTE) in patients with cancer, including those infected with COVID-19.
The ITAC guidelines are available on a free, Web-based mobile phone application; more information is available at itaccme.com.
As stated by the authors, “Cancer-associated VTE, which includes deep-vein thrombosis, pulmonary embolism, and central venous catheter–related VTE, is the second-leading cause of death in patients with cancer after [disease] progression.”
Key Recommendations
Key recommendations from the 2022 guidelines, based on literature review through January 2022, include the following:
- Use of low–molecular weight heparins (LMWHs) for the initial treatment (first 10 days) and maintenance treatment of cancer-associated thrombosis
- Use of direct oral anticoagulants for the initial treatment and maintenance treatment of cancer-associated thrombosis in patients who are not at high risk of gastrointestinal or genitourinary bleeding, in the absence of strong drug-drug interactions or of gastrointestinal absorption impairment
- Use of LMWHs or direct oral anticoagulants for a minimum of 6 months to treat cancer-associated thrombosis
- Use of extended prophylaxis (4 weeks) with LMWHs to prevent postoperative VTE after major abdominopelvic surgery in patients not at high risk of bleeding
- Use of primary prophylaxis of VTE with LMWHs or direct oral anticoagulants (rivaroxaban or apixaban) in ambulatory patients with locally advanced or metastatic pancreatic cancer who are treated with anticancer therapy and have a low risk of bleeding.
Guidance for Patients With Cancer Infected With COVID-19
Recommendations specifically for COVID-19–infected patients with cancer include:
- Recommendations for treatment of established VTE and for prophylaxis of VTE are similar irrespective of whether patients have COVID-19.
- Patients with COVID-19 should be assessed for risk of VTE as with any other patient with COVID-19, whether they are hospitalized, postdischarge, or ambulatory.
- Pharmacologic prophylaxis during hospitalization should be given with the same dose and anticoagulant type as in patients with cancer who do not have COVID-19 based on current institutional practice.
- Postdischarge VTE prophylaxis is not advised in patients with COVID-19; as with any patient with cancer, individual assessment of benefit-risk ratio should be performed.
- Primary pharmacologic prophylaxis of VTE in ambulatory patients with COVID-19 is not routinely recommended.
The authors concluded, “Cancer-associated VTE remains an important clinical problem associated with increased morbidity and mortality. The 2022 updated ITAC guidelines incorporate emerging data within established approaches for the prevention and treatment of cancer-associated thrombosis. The ITAC guidelines’ companion free Web-based mobile application will assist the practicing clinician with decision-making at various levels to provide optimal care of patients with cancer to treat and prevent VTE.”
Dominique Farge, MD, PhD, of Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Nord-Université de Paris, is the corresponding author for The Lancet Oncology article.
Disclosure: For full disclosures of the study authors, visit thelancet.com.
