Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Guideline Update

A partir d'une revue systématique de la littérature publiée entre 2018 et 2022 (5 essais randomisés), cette étude présente les recommandations actualisées de l'"American Sociéty of Clinical Oncology" concernant la prévention et la prise en charge d'une thromboembolie veineuse chez les patients atteints d'un cancer

Résumé en anglais

PURPOSE: To conduct an update of the ASCO venous thromboembolism (VTE) guideline.

METHODS: After publication of potentially practice-changing clinical trials, identified through ASCO's signals approach to updating, an updated systematic review was performed for two guideline questions: perioperative thromboprophylaxis and treatment of VTE. PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) published between November 1, 2018, and June 6, 2022.

RESULTS: Five RCTs provided information that contributed to changes to the 2019 recommendations. Two RCTs addressed direct factor Xa inhibitors (either rivaroxaban or apixaban) for extended thromboprophylaxis after surgery. Each of these postoperative trials had important limitations but suggested that these two oral anticoagulants are safe and effective in the settings studied. An additional three RCTs addressed apixaban in the setting of VTE treatment. Apixaban was effective in reducing the risk of recurrent VTE, with a low risk of major bleeding.

RECOMMENDATIONS: Apixaban and rivaroxaban were added as options for extended pharmacologic thromboprophylaxis after cancer surgery, with a weak strength of recommendation. Apixaban was also added as an option for the treatment of VTE, with high quality of evidence and a strong recommendation.

Additional information is available at www.asco.org/supportive-care-guidelines.