Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2016; 8(3): 258-270
Published online Mar 15, 2016. doi: 10.4251/wjgo.v8.i3.258
Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers - Review
Hanno Riess, Piet Habbel, Anja Jühling, Marianne Sinn, Uwe Pelzer
Hanno Riess, Piet Habbel, Anja Jühling, Marianne Sinn, Uwe Pelzer, Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine Berlin, 10117 Berlin, Germany
Author contributions: Riess H and Pelzer U made substatial contributions to the conception of the review; Riess H, Habbel P, Jühling A, Sinn M and Pelzer U contributed to the acquisition, analysis and interpretation of the published data; they participated in the drafting of the review and gave final approval.
Conflict-of-interest statement: Hanno Riess has received fees for serving as a speaker for Aspen Europa, Bayer Healthcare AG, Bristol Myers Squipp, Boehringer Ingelheim, Daiichi-Sankyo, Leo Pharma, Novartis Pharma, Pfizer Pharma and Sanofi-Aventis. Piet Habbel and Anja Jühling have no conflict of interest to declare. Marianne Sinn received travel support and honoraria for scientific presentations from Bayer Healthcare, Celgene, Roche Pharma, Leo Pharma. Uwe Pelzer received travel support and honoraria for scientific presentations from Celgene, Amgen, Braun.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Hanno Riess, Professor, Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany. hanno.riess@charite.de
Telephone: +49-30-450513002 Fax: +49-30-450513952
Received: July 7, 2015
Peer-review started: July 8, 2015
First decision: October 13, 2015
Revised: December 7, 2015
Accepted: December 29, 2015
Article in press: January 4, 2016
Published online: March 15, 2016
Processing time: 244 Days and 11.3 Hours
Abstract

Venous thromboembolism event (VTE) is a common and morbid complication in cancer patients. Patients with gastrointestinal cancers often suffer from symptomatic or incidental splanchnic vein thrombosis, impaired liver function and/or thrombocytopenia. These characteristics require a thorough risk/benefit evaluation for individual patients. Considering the risk factors for the development of VTE and bleeding events in addition to recent study results may be helpful for correct initiation of primary pharmacological prevention and treatment of cancer-associated thrombosis (CAT), preferably with low molecular weight heparins (LMWH). Whereas thromboprophylaxis is most often recommended in hospitalized surgical and non-surgical patients with malignancy, there is less agreement as to its duration. With regard to ambulatory cancer patients, the lack of robust data results in low grade recommendations against routine use of anticoagulant drugs. Anticoagulation with LMWH for the first months is the evidence-based treatment for acute CAT, but duration of secondary prevention and the drug of choice are unclear. Based on published guidelines and literature, this review will focus on prevention and treatment strategies of VTE in patients with gastrointestinal cancers.

Keywords: Thromboembolism; Gastrointestinal cancer; Prophylaxis; Treatment; Anticoagulation

Core tip: The risk for venous thrombosis and pulmonary embolism is clearly elevated in patients with gastrointestinal cancers. This risk is highest for patients with pancreatic, gastric or colorectal cancer and those receiving anti-cancer therapies. Available guidelines usually refer to thromboembolism in cancer patients without differentiating between types of cancer. Those patients with gastrointestinal cancers are more likely to present with additional problems such as hepatopathy-associated low platelet counts and/or prolonged prothrombin times. Furthermore, symptomatic or incidental thromboembolism of the visceral veins may occur more often. Identifying the risk factors for the development of venous thromboembolism and bleeding events may be helpful for correct initiation of primary pharmacological prevention and treatment of cancer-associated thromboembolism. Based on published guidelines and literature, this review will focus on prevention and treatment strategies of venous thromboembolism in patients with gastrointestinal cancers.