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Cancer-associated thrombosis (CAT)

Declaration of sponsorship Pfizer and Bristol Myers Squibb
Read time: 50 mins
Last updated:9th Mar 2022
Published:25th Feb 2022

Take an in-depth look at thrombosis in cancer (cancer-associated thrombosis, CAT), the second leading cause of death in patients with malignant tumours.

  • Join Professor Agnelli from the University of Perugia to explore the prevalence of CAT and how to identify those at risk
  • Explore options for prevention of CAT and for initial, short-term and long-term treatment
  • Learn about the key evidence behind inclusion of direct acting oral anticoagulants (DOACs) as options for prevention and treatment of CAT in 2021 guidelines

About cancer-associated thrombosis

Cancer-associated thrombosis (CAT) collectively refers to thrombotic events in patients with cancer, and most commonly includes types of venous thromboembolism (VTE) such as deep vein thrombosis (DVT) and pulmonary embolism (PE)1. It also includes less common types of VTE, such as visceral or splanchnic vein thrombosis, and arterial occlusion with stroke and symptoms of angina1.

Prevalence and impact of cancer-associated thrombosis

Professor Agnelli describes the prevalence of CAT, and the challenges of treating patients with the condition.

What are the challenges of treating CAT?

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Risk assessment for cancer-associated thrombosis

Professor Agnelli outlines the key risk factors for cancer-associated thrombosis (CAT), and how clinicians can stratify patients based on their risk of thrombosis, to help inform treatment options.

What are the risk factors for CAT and what risk stratification tools are available?

How can physicians stratify patients based on risk?

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Management of cancer-associated thrombosis

Management of VTE in patients with cancer can be complex, considering cancer not only increases the risk of venous thromboembolism (VTE), but is also associated with an increased risk of bleeding3.

Professor Agnelli from the University of Perugia discusses the unmet needs in treating patients with cancer-associated thrombosis (CAT).


Guidelines for managing patients with cancer and VTE

Considering the unique pathophysiology of thrombosis in patients with cancer, as well as additional considerations for treatment, specific guideline recommendations are available to inform management of CAT.

Guidelines for CAT include the:

  • 2021 American Society of Hematology (ASH) guidelines3
  • 2021 National Comprehensive Cancer Network (NCCN) guidelines13

Recommendations for management of VTE in patients with cancer are also provided in the:

  • 2019 European Society for Cardiology/European Respiratory Society (ESC/ERS) guidelines10
  • 2019 American Society of Clinical Oncology (ASCO) guidelines19
  • 2020 ASH guidelines20
  • 2021 European Society for Vascular Surgery (ESVS) guidelines11
  • 2019 International Society for Thrombosis and Hemostasis (ISTH) guidelines21

The 2021 ASH, NCCN and ESVS guidelines include the following:

  • Direct acting oral anticoagulants (DOACs) are recommended as an option for VTE prophylaxis (thromboprophylaxis) in patients with cancer3,13
  • Recommendations on types of anticoagulants for use for initial, short and long-term anticoagulation for VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]) in patients with cancer3,13
  • Updated recommendations for managing DVT in patients with cancer11

Thromboprophylaxis for patients with cancer at risk of VTE

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Direct acting oral anticoagulants in cancer-associated thrombosis

Professor Agnelli discusses the evidence for direct oral anticoagulants (DOACs) in the treatment of venous thromboembolism (VTE) in patients with cancer, and whether DOACS may help to overcome some challenges in managing CAT.

Is there sufficient data to support use of DOACs for treatment of CAT

Could DOACs overcome issues in management of CAT

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References

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