CHU Rennes, Hôpital Sud, Service de médecine interne et d’immunologie clinique,
16 boulevard de Bulgarie - 35203 RENNES Cedex 2, BP 90347
CHU Rennes, Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000 Rennes
CHU Rennes, Laboratoire d’hémostase
Venous thromboembolism (VTE) is an important cause of morbidity and mortality among patients with cancer. Update recommendations on this topic have been proposed in 2019.
For VTE prophylaxis, hospitalized patients who have active malignancy and acute medical illness or reduced mobility should be offered pharmacologic thromboprophylaxis in the absence of bleeding or other contraindications. Moreover, all patients with malignant disease undergoing major surgical intervention should be offered pharmacologic thromboprophylaxis that should be continued up to 4 weeks post-operatively for patients undergoing major open or laparoscopic abdominal or pelvic surgery in the absence of high bleeding risk or other contraindications.
For treatment of patients with cancer with established VTE, long-term anticoagulation may involve low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). VKAs are inferior but may be used if LMWH or DOACs are not accessible. There is an increase in major bleeding risk with DOACs, particularly in GI malignancies. LMWH should be use for cancer patients with acute diagnosis of VTE and high risk of bleeding, including patients with gastrointestinal cancers. DOACs are acceptable alternatives if there are no drug-drug interactions, no severe renal impairment, incorporating patient preferences.