Prophylaxis and treatment of thromboembolism in oncology

In this article, following guidelines for clinical practice are formulated. 1. For patients undergoing cancer surgery, pharmacological thromboprophylaxis is recommended. Low molecular weight heparins (LMWH), unfractionated heparin (UFH) 5,000 U three times daily, or fondaparinux are recommended; in the Czech Republic, LMWH are most frequently used. For patients undergoing major cancer surgery extended prophylaxis for 4 weeks is recommended. For patients with a high risk of bleeding, intermittent pneumatic compression presents a reasonable alternative. 2. For cancer patients, who are bedridden, or hospitalized with an acute illness, thromboprophylaxis with LMWH is recommended. Patients with multiple myeloma, undergoing induction therapy, including at least 2 thrombogenic drugs (thalidomide, lenalidomide, dexamethasone, prednison, and anthracyclines) should be treated with LMWH. In other cancer patients, pharmacological thromboprophylaxis is not generally recommended, however, its application should be considered namely in patients with a history of venous thromboembolism (VTE), or in the presence of multiple risk factors. The cancer patients with VTE should be treated with LMWH for the first 6 months; the initial dose being 200 IU/kg daily, this can be reduced to 2/3-3/4 after one month. The therapy should be reevaluated after 6 month and subsequent therapy using LMWH or warfarin is recommended indefinitely, unless the cancer is resolved or any major contraindications arise.