Consensus statement of the Spanish Society of Internal Medicine and the Spanish Society of Medical Oncology on secondary
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SPECIAL ARTICLE
Consensus statement of the Spanish Society of Internal Medicine and the Spanish Society of Medical Oncology on secondary thromboprophylaxis in patients with cancer T. Quintanar1 · C. Font2 · E. Gallardo3 · R. Barba4 · B. Obispo5 · C. Díaz‑Pedroche6 Received: 1 August 2020 / Accepted: 10 August 2020 © The Author(s) 2020
Abstract Up to 20% of cancer patients will develop some manifestation of venous thromboembolic disease (VTD) during their clinical course. VTD greatly impacts morbidity, mortality, quality of life and pharmaceutical expenditure. In addition, both thrombotic relapse and major haemorrhages derived from VTD treatment are more likely in oncological patients. To make the decision to establish secondary thromboprophylaxis as an indefinite treatment in these patients, it is important to review all the risk factors involved, whether related to the disease, the patient or the prior thrombotic event. The objectives of this consensus of the Spanish Society of Internal Medicine (Sociedad Española de Medicina Interna—SEMI) and the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica—SEOM) are to establish recommendations that help assess the risk of recurrence of VTD and haemorrhagic risk in patients with cancer, as well as to analyse the evidence that exists on the currently available drugs, which will allow the establishment of a protocol for shared decision-making with the informed patient. Keywords Anticoagulants · Haemorrhage · Low-molecular-weight heparin · Neoplasms · Vitamin K · Venous thrombosis
Introduction The advances in antineoplastic treatment of most solid tumours have resulted in an increase in overall survival in patients with advanced disease [1]. Managing complications of cancer treatment, therefore, has value in improving survival and quality of life. Up to 20% of cancer patients will develop some manifestation of venous thromboembolic disease (VTD) during their clinical course, making it one of the main cardiovascular complications from the first year
after diagnosis [2] with a major impact on morbidity, mortality, quality of life, and pharmaceutical expenditure. Both recurrence of and major haemorrhages from VTD treatment are more frequent in cancer patients [3]. This has led researchers to explore other anticoagulant treatment options in this scenario. Low-molecular-weight heparin (LMWH) has been established as the main therapeutic tool based on its greater efficacy observed against vitamin K antagonists (VKA) in the CLOT study and other studies during the first 3–6 months of treatment [4, 5].
* T. Quintanar [email protected]
1
Department of Medical Oncology, Hospital General Universitario de Elche y Vega Baja, Elche, Alicante, Spain
C. Font [email protected]
2
Department of Internal Medicine, Hospital Clinic, Barcelona, Spain
E. Gallardo [email protected]
3
R. Barba [email protected]
Department of Medical Oncology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT,
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