Thrombosis in Cancer: A Medical Professional's Guide to Cancer Associated Thrombosis

VTE Prophylaxis

Author(s): Fawzi Abu Rous, Manoj Rai*, Osama Mosalem, Layan El-khatib*, Calvin Abro and Abdullah Al-abcha

Pp: 104-115 (12)

DOI: 10.2174/9781681087849121010013

* (Excluding Mailing and Handling)

Abstract

Cancer patients have an increased risk of VTE and its complications. It has been of utmost importance to identify high-risk patients. The Khorana score, which stratifies cancer patients into low and high risk, includes cancer type, chemotherapy regimen, hematological factors, and combinations of clinical and lab factors. In hospitalized cancer patients with limited mobility, pharmacologic prophylaxis with low molecular weight heparin (LMWH) or unfractionated heparin (UFH) is recommended. In those with contraindications to anticoagulation, mechanical prophylaxis can be used. In cancer patients undergoing surgery, perioperative VTE prophylaxis using pharmacologic anticoagulation is recommended, unless a minor procedure or an anticoagulant contraindication exists. In outpatients, the American Society of Clinical Oncology (ASCO) did not recommend routine anticoagulation in cancer patients except in high risk (e.g., Khorana score ≥2, or multiple myeloma, receiving thalidomide or lenalidomide). Those patients should be offered VTE prophylaxis with apixaban, rivaroxaban, or LMWH. Also, ASCO recommended periodic assessment of cancer patients for VTE risk and educating them about VTE's signs and symptoms.


Keywords: Apixaban, Cancer-associated thrombosis, Contraindication to anticoagulation, Khorana Score, LMWH, Malignancy in cancer, Mechanical VTE prophylaxis, Pharmacological anticoagulation, Rivaroxaban, Thromboprophylaxis in cancer, VTE, VTE prophylaxis.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 221922387 and j.to_ip >=221922387 )) and ((j.from_date <= 1739834843 and j.to_date >= 1739834843 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14927) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 221922387 and j.to_ip >=221922387 )) and ((j.from_date <= 1739834843 and j.to_date >= 1739834843 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14927) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 221922387 and j.to_ip >=221922387 )) and ((j.from_date <= 1739834843 and j.to_date >= 1739834843 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14927)
      570μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3072 and `b`.`banner_from_date` <= 1739834843 and `b`.`banner_to_date` >= 1739834843 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.06msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3072
      • 3: 1739834843
      • 4: 1739834843
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='5d53b5cd4ef9793165b576718e0d72af'
      300μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    12Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        QSNTESKMmhoHAH38NUWqBcHaFQ4j3VkKQJZhgfyv
        uc_cart_id
        5d53b5cd4ef9793165b576718e0d72af
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/14927" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/14927
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6IjZWa1NadE9oSkRHSlV1ZnpmWTVkTmc9PSIsInZhbHVlIjoieVVNdmd5RkdmYlpDTzc2WFhjWEF0c3pXdWR1NnZPSmlEVFQ2MjgwNms4OEl1UHBjdlJlTGVBbms0N3NVK1dSRSIsIm1hYyI6ImNkYWYwYmYwZTgzYjRjNzEzMDVlNzI1NmY2ZDJhM2Q2ZDIwNjg3NzRjOWIzNGViM2M3ODYwMjdlN2QxODhmY2UiLCJ0YWciOiIifQ%3D%3D; XSRF-TOKEN=eyJpdiI6ImdsYWFLOUtBVnFSK3VtTGdYSHRUeXc9PSIsInZhbHVlIjoiWFFNWUdrMWNEUXdIVzJKZWIvaVRoalNWTnl4V1NkR1RjNWg4MDlkWlhtTU9HU2svOHVTcTNCL1RzdEhjeEVIS0hHdjArTldTTlZsdENwUHhLZmk2RUcvekdwdzBUNzhxL2sxc2NNMlh1K0Qza29xQ2o0U2MzclNaTyt3RjBUUDYiLCJtYWMiOiJmMzc1NDkwY2U0Yjk4ODcxMzBlNzU5ZWMxNDQ0NjM0Y2JkNmZjZjRlZTRlYTFjMzI1YzMzZmY1OGI5NjBlN2ZhIiwidGFnIjoiIn0%3D; alphaeurekaselectnet_session=eyJpdiI6Im1WdjlFQWhmejRoSTVNV2pDV1REZFE9PSIsInZhbHVlIjoiUHFjcDNidGlUN3cydVJSb1QxV2g4RWlERXJBNkc0dGNYNEJxY3RpejNTWVhrY0tyWURSOGtRdy84YVRIdlJrdjQrTHMyK0IzK2phckNBSVpQUTV6NWVxdUtiSCs4U1VXbWFsNXMvOU5sMy9hR05Gak1kUFg0MG1zc21MYWhTR24iLCJtYWMiOiI2MjNmYmE5MDdmZWQ2ODFlOTVhMDAyZTQzOWFiMjEwMjQ2YjljNzJlZWFhNjljOGVhZTMzYWZjNmI2YjUzN2JhIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6IjZWa1NadE9oSkRHSlV1ZnpmWTVkTmc9PSIsInZhbHVlIjoieVVNdmd5RkdmYlpDTzc2WFhjWEF0c3pXdWR1NnZPSmlEVFQ2MjgwNms4OEl1UHBjdlJlTGVBbms0N3NVK1dSRSIs" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
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        response_headers
        0 of 0
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        session_attributes
        0 of 0
        array:5 [ "_token" => "QSNTESKMmhoHAH38NUWqBcHaFQ4j3VkKQJZhgfyv" "uc_cart_id" => "5d53b5cd4ef9793165b576718e0d72af" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/14927" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-17 23:27:23GET/chapter/149271121914