Prophylaxis and management of venous thromboembolism in patients with advanced cancer

Venous thromboembolism (VT) is a common problem in patients with advanced cancer, worsening the prognosis and quality of life. However, prophylaxis and treatment of VT in this population is controversial because of high risk of bleeding and shortage of evidence supporting such management. The decision to start anticoagulants must be taken individually, balancing risk of VT and bleeding, and burden of treatment. Patient’s preference should also be considered. In addition to the known contraindications, patients who are dying, or who are on end of life care pathway are not suitable for anticoagulation. There are some data to support thromboprophylaxis in hospitalized patients with acute medical conditions, subjects undergoing surgery lasting more than 30 minutes, and patients who have undergone hip replacement or hip fracture surgery. In contrast, there is no evidence of efficacy of prophylaxis in all inpatients with cancer. The treatment of choice is low molecular weight heparin.