Thromboembolism During Neoadjuvant Therapy for Gastrointestinal Cancer

• Published in: American journal of clinical oncology Vol. 37; no. 6; pp. 627 - 634
• Main Authors: SMART, Philip J, BURBURY, Kate L, LYNCH, A. Craig, MACKAY, John R, HERIOT, Alexander G
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-12-2014
• Subjects: Anticoagulants - therapeutic use; Antineoplastic agents; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chemoradiotherapy - adverse effects; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Neoplasms - complications; Gastrointestinal Neoplasms - therapy; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoadjuvant Therapy - adverse effects; Pharmacology. Drug treatments; Practice Guidelines as Topic; Pulmonary Embolism - etiology; Pulmonary Embolism - prevention & control; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Venous Thrombosis - etiology; Venous Thrombosis - prevention & control; Gastrointestinal cancer; Cardiovascular disease; Malignant tumor; Chemoradiotherapy; Thrombosis; neoadjuvant therapy; Embolism; Neoadjuvant treatment; Vascular disease; Digestive diseases; Intestinal disease; Thromboembolism; Cancer; Gastric disease
• ISSN: 0277-3732; 1537-453X
• DOI: 10.1097/COC.0b013e318280d78a

Thromboembolism a common, costly, and morbid complication that is also associated with decreased survival in cancer patients. The risk of thromboembolism in cancer patients is underappreciated. In addition to symptomatic deep venous thrombosis and pulmonary embolism, asymptomatic and arterial thromboembolic events are important consideration in ambulatory cancer patients receiving neoadjuvant chemoradiotherapy (nCRT). No specific randomized trial examining thromboprophylaxis (TP) during nCRT for gastrointestinal cancer has been performed, and none is accruing. Most guidelines currently recommend against TP in ambulatory cancer patients due to a lack of data rather than proof of harm or lack of efficacy. It is clear that robust data are urgently required, and that treatment with nCRT in patients with gastrointestinal malignancy is not an indication for routine pharmacological TP at the present time.