Current Management of Cancer-Associated Thromboembolism in the Prophylactic and Acute Setting

Purpose of reviewThe goal of this review is to provide the reader with an overview of cancer-associated thromboembolism (CAT) and current therapeutic approaches to its primary prevention and initial treatment.Recent findingsGiven several favorable randomized trials of chemoprophylaxis for CAT, recent work has focused on patient risk stratification and prophylaxis optimization. The Khorana Score remains the "gold standard" for risk assessment among ambulatory outpatients though updated models are in development; data are more limited to endorse prophylaxis among inpatients. For acute treatment, the growing body of evidence in support of direct oral anticoagulants has revolutionized CAT management. Research is ongoing to better define appropriate populations and therapeutic duration in the setting of increasing pharmacologic options.SummaryAnticoagulation is recommended for acute CAT treatment and prophylaxis in carefully selected patients with cancer. The decision of if, when, and how to anticoagulate patients with CAT ultimately varies with patient characteristics, concomitant medications, goals of care, and careful risk-benefit analysis.