Inpatient primary prophylaxis of cancer-associated thromboembolism (CAT)

Purpose Cancer-associated thrombosis (CAT) increases morbidity and mortality in oncology patients. The risk of CAT is increased with hospitalization for acute medical illness. The goal of this review will be to examine the available evidence for (1) risk assessment and (2) primary thromboprophylaxis, (3) international published guideline recommendations, and (4) future directions to manage oncology patients admitted for an acute medical illness. Methods A review was performed for each subject to gather information on the available evidence and recommendations available for oncology patients hospitalized for an acute medical illness. Results Risk assessments for thrombosis are primarily developed and validated in the general population. There is not a risk assessment that has specifically been developed and validated in oncology patients hospitalized for an acute medical illness. Most evidence for thromboprophylaxis of oncology patients is from sub-group analysis of larger randomized-controlled trials in the general population. Evidence is conflicting and suggests an individualized approach evaluating the risk-benefit of thromboprophylaxis. The strength of recommendations of international guidelines is limited because of the available evidence. Guidelines usually recommend utilizing and/or offering thromboprophylaxis to oncology patients hospitalized for an acute medical illness barring contraindications. Future evidence needs to improve risk assessments and knowledge of the appropriate agent, dose, and duration of thromboprophylaxis if indicated. Conclusion Evidence for risk assessments and primary prophylaxis for oncology patients hospitalized for acute medical illness appears limited, with many research opportunities available to improve understanding on management of this patient population.

Automated summary

This review examines the available evidence for risk assessment and primary thromboprophylaxis for oncology patients hospitalized for acute medical illness. The results show that risk assessments for thrombosis are primarily based on studies conducted in the general population and there is a lack of specific risk assessment for oncology patients. Evidence for thromboprophylaxis in oncology patients is conflicting and mainly comes from sub-group analysis of larger studies in the general population. The strength of recommendations from international guidelines is limited due to the lack of sufficient evidence. Future research should focus on improving risk assessment and understanding the appropriate treatment for this patient population.