82例血液恶性肿瘤合并静脉血栓栓塞症患者的临床特点分析

目的:探讨血液系统肿瘤患者合并静脉血栓栓塞症(venous thromboembolism,VTE)的临床特点.方法:回顾性分析2012年1月至2020年12月宁夏医科大学总医院收治的82例血液肿瘤合并VTE患者的住院资料并作为病例组,以同期100例未合并VTE的血液肿瘤患者为对照组.结果:血液肿瘤并发VTE以急性白血...     

恶性肿瘤与静脉血栓形成关系的研究进展

恶性肿瘤与静脉血栓栓塞（venous thromboembolism，VTE）关系密切。恶性肿瘤患者发生VTE，不仅增加治疗难度，而且降低患者生存质量及减少生存预期，因此越来越受到，临床医生重视，成为近期肿瘤研究的热点问题之一。肿瘤细胞可以直接分泌癌促凝物质，或通过激活单核细胞和巨噬细胞释放细胞因子。这些蛋白质因子诱导凝血反应，增加发生VTE的风险。某些特定类型的肿瘤，如原发性脑肿瘤、胰腺癌、卵巢癌、乳腺癌、结直肠癌及非小细胞肺癌发生VTE的风险较高。此外，多种原因所致静脉血液淤滞、抗肿瘤药物及孕激素类药物治疗也是VTE发生的危险因素。通过详细的病史询问、体格检查及相关实验室检查可以诊断大部分自发性VTE患者的隐匿性恶性肿瘤。进一步的检查手段能否增加患者生存受益，有待于进一步的临床试验研究。肿瘤患者外科术前予普通肝素、低分子量肝素（low molecular weighthepann，LMWH）及戊聚糖预防治疗可以有效降低发生VTE的风险，且三类药物具有相似效果。此类患者术后继续行LMWH抗凝治疗亦可以减少VTE的发病率。低剂量抗凝治疗并未降低行中心静脉插管的肿瘤患者发生导管相关血栓形成（catheter—related thrombosis，CRT）的风险。对肿瘤内科患者行抗凝预防治疗的必要性及有效性尚未明确。要制定预防血栓形成的最佳策略，仍有待于临床继续深入研究。     

肿瘤细胞减灭加腹腔热灌注化疗术后静脉血栓栓塞症的预防

  目的  评估行肿瘤细胞减灭术（cytoreductive surgery，CRS）加腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy，HIPEC）治疗的腹膜癌患者静脉血栓栓塞症（venous thromboembolism，VTE）发生风险，研究术后早期主/被动活动联合间歇充气加压按摩对VTE的预防效果。  方法  对2015年5月至2016年8月武汉大学中南医院肿瘤科收治的120例胃肠道及妇科肿瘤等来源的腹膜癌患者行CRS+HIPEC治疗，使用Caprini血栓风险评估模型评价VTE风险，所有患者采取早期肢体主/被动活动及间歇充气加压按摩治疗，记录分析VTE相关事件。  结果  患者中位Carprini评分为12（10~16）分，均为VTE极高危组，在3个月的随访中仅1例患者发生深静脉血栓，经药物治疗后痊愈。  结论  腹膜癌患者VTE风险极高，术后早期足背曲/跖曲及扩胸等主/被动运动联合间歇充气加压按摩，可有效预防VTE。      

宫颈癌患者合并静脉血栓栓塞症的危险因素和治疗

目的:探讨宫颈癌化疗患者合并静脉血栓栓塞症的危险因素与治疗.方法:回顾性分析2010年至2015年我院158例宫颈癌化疗患者,按是否合并静脉血栓栓塞症(VTE)分成VTE组(n=40)与无VTE组(n=118),记录分析两组的性别、年龄、既往史、病例类型、肿瘤分期、血小板计数、血黏稠度、D-二聚体以及治疗措施.结果:VET组Ⅳ期:90.00%,血黏稠度增高:67.50%,D-二聚体增高:70.00%;无VTE组Ⅳ期:70.34%,血黏稠度增高:46.61%,D-二聚体增高:49.15%(均P<0.05).Logistic回归显示:肿瘤分期、D-二聚体水平以及血黏稠度与宫颈癌化疗患者发生静脉血栓高度相关,差异均有统计学意义(均P<0.05).40例宫颈癌化疗合并VTE患者2例并发大出血死亡;其余经溶栓、抗凝治疗后19例治愈,4例好转,总有效率为57.50%.结论:宫颈癌肿瘤分期晚、D-二聚体水平高以及血黏稠度高与宫颈癌化疗患者发生静脉血栓高度相关,为宫颈癌患者并发VTE的高危因素;及时评价宫颈癌化疗患者合并VTE的高危因素,及早抗凝治疗,可预防及减少并发VTE,同时提高治疗效果.     

99例晚期恶性肿瘤患者静脉血栓栓塞症的诊治情况分析

目的:了解晚期恶性肿瘤患者合并静脉血栓栓塞症（venous thromboembolism,VTE)的诊治及预防情况,加强肿瘤相关性VTE的认知,提高患者生活质量及改善预后。方法:收集2012年1月至2016年10月住院确诊为VTE的肿瘤患者（VTE组）的病历资料,与同时期入院的非VTE的肿瘤患者对照（对照组）,对两组资料进行Logistic回归分析,寻找可能的VTE高危因素。结果:VTE组及对照组各99例患者。VTE组中,年龄>60岁64例,ZPS评分>2分57例,IV期65例;以彩超确诊者84例,以CT诊断者15例;发生在下肢深静脉者71例。VTE组:49例应用低分子肝素抗凝,出院后应用华法林后续治疗10例,大多数VTE组患者未应用预防性抗凝。在多因素Logistic回归分析中,血红蛋白下降、凝血酶时间延长以及中心静脉置管的应用在统计学上存在显著的差异。结论:恶性肿瘤合并VTE多发生在60岁以上、IV期和活动不良的患者,其后续抗凝治疗不足,临床上缺乏主动预防的措施及意识。     

恶性肿瘤合并静脉血栓形成相关危险因素及风险评估

静脉血栓(VTE)是恶性肿瘤的常见并发症,静脉血栓可发生于肿瘤形成的任何阶段并有较高的死亡率和致残率.本文就恶性肿瘤合并静脉血栓形成的相关危险因素及风险评估等方面做一综述,利于早期识别恶性肿瘤合并静脉血栓,并作早期治疗.     

淋巴瘤相关血栓的临床分析

  目的  本研究主要分析和总结淋巴瘤（Malignant lymphoma, ML）患者发生静脉血栓栓塞（venous thrombolism, VTE）的临床特点, 为预防和治疗ML相关VTE提供有效依据。  方法  回顾性分析天津医科大学附属肿瘤医院2000年1月至2009年12月收治的经病理证实的4 256例ML患者的临床资料, 病理诊断依据WHO的造血与淋巴组织肿瘤分类标准（第4版）。  结果  ML相关VTE的发病率为7.1%, NHL患者并发VTE的发病率为5.7%, HL患者并发VTE的发病率为1.3%;16.4%的患者在治疗前形成血栓, 75.8%的患者血栓发生在化疗的前3个周期。上肢和颈部静脉血栓事件共146次（48.4%）, 下肢静脉血栓事件共89次（29.5%）。  结论  ML相关VTE的发病率较高, 上肢和颈部静脉血栓发生率较下肢更常见, 在化疗的前3个周期中血栓的发生率最高。      

肺癌合并静脉血栓栓塞症89例临床分析

目的:本研究旨在探讨肺癌合并静脉血栓栓塞症(venous thromboembolism,VTE)患者的临床相关因素,为肺癌合并VTE的预防及治疗提供依据。方法:对2008年7月-2010年6月收治的经细胞学或病理学确诊的2053例肺癌病例进行回顾性分析。采用螺旋CT、肺动脉造影及彩色多普勒超声检查明确VTE诊断。将年龄、性别、病理类型、肺癌分期、手术、体质量指数、基础疾病、治疗前血小板计数、D-二聚体、白细胞介素1和肿瘤坏死因子作为临床相关因素。结果:2053例肺癌患者中,89例(4.34%)患者合并VTE。腺癌患者的VTE发生率为5.65%(58/1027),非腺癌患者为3.02%(31/1026),差异有统计学意义(P=0.003);Ⅰ～ⅢA期患者的VTE发生率为1.48%(10/677),ⅢB～Ⅳ期患者的VTE发生率为5.74%(79/1376),差异有统计学意义(P<0.001);Ⅰ～ⅢA期接受手术治疗患者的VTE发生率为1.55%(10/645),未行手术治疗患者的VTE发生率为0%(0/32),差异有统计学意义(P=0.044);无基础疾病患者的VTE发生率为2.70%(33/1221),伴随基础疾病患者的VTE发生率为6.73%(56/832),差异有统计学意义(P<0.001)。治疗前,血小板计数、D-二聚体、白细胞介素1和肿瘤坏死因子水平正常者的VTE发生率分别为3.72%、0.31%、2.44%和3.27%,而水平升高者的VTE发生率分别为6.26%、19.91%、10.26%和7.74%,差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示,腺癌、手术、基础疾病以及D-二聚体、白细胞介素1和肿瘤坏死因子水平升高是肺癌患者发生VTE的相关临床因素(P<0.05)。结论:肺癌合并VTE患者中,腺癌是最常见的病理类型。手术、基础疾病以及D-二聚体、白细胞介素1和肿瘤坏死因子水平升高是肺癌患者发生VTE的危险因素。     

肿瘤患者静脉血栓栓塞症的风险评估模型及其应用

静脉血栓栓塞症（VTE）是肿瘤患者常见的并发症和死亡原因。多项研究显示,有效的VTE风险评估模型和恰当的预防性抗凝治疗可以降低肿瘤患者的血栓发生风险。但哪些肿瘤患者需要进行预防性抗凝治疗,需要有效的VTE风险评估模型,对肿瘤患者进行VTE风险分层。对血栓高危人群,在排除抗凝禁忌证后进行预防性抗凝。但肿瘤疾病存在复杂性,不同的病理类型和分期,VTE风险和特点不同,而目前专门针对肿瘤患者的VTE风险评估模型仍然有限,本文将对肿瘤患者的VTE风险评估模型的现状及其应用进行综述。     

肺癌合并静脉血栓栓塞症患者的诊疗特点

目的 探讨静脉血栓栓塞症（VTE）对肺癌患者原发疾病诊疗方案的影响。方法 回顾性分析北京大学肿瘤医院收治的肺癌患者中，发生VTE患者的临床资料。计算肺癌患者VTE的发生率，分析VTE对原发疾病肺癌的影响。结果 1766例肺癌患者中有115例（6.5%）发生VTE，其中男性78例（67.8%）。深静脉血栓82例（71.3%）、肺栓塞21例（18.3%）、肺栓塞合并深静脉血栓12例（10.4%）。症状性VTE 74例（64.3%）。102例（88.7%）患者进行抗血栓治疗。在抗血栓治疗的患者中，97例（95.1%）患者使用药物治疗，其中65例（67.0%）患者使用了足量或标准剂量。52例（45.2%）患者VTE治疗后显效或者有效，32例（27.8%）经治疗后无效或者恶化，31例（27.0%）未复查或者情况不详。11例（9.6%）患者在抗血栓治疗中发生出血等不良反应。30例（26.1%）患者因为VTE导致抗肿瘤治疗方案改变。结论 VTE是肺癌患者的常见并发症。肺癌合并VTE患者的抗血栓治疗情况复杂，治疗效果不理想，出血等不良反应风险较高。VTE严重影响原定抗肿瘤治疗方案的实施。     

Outpatient use of low molecular weight heparin monotherapy for first-line treatment of venous thromboembolism in advanced cancer

Background.

Evidence-based treatment guidelines recommend low molecular weight heparin (LMWH) monotherapy for cancer-associated venous thromboembolism (VTE). This analysis assessed the first-line treatment strategies for VTE in patients with advanced solid tumors.

Methods.

Using administrative data from advanced lung, prostate, colon, or breast cancer patients diagnosed between January 2000 and December 2007 at four HMOs with integrated delivery systems, patients with an inpatient or outpatient VTE diagnosed within 2 years after cancer diagnosis and an outpatient purchase of warfarin, LMWH, and/or fondaparinux anticoagulant within 7 days of the VTE diagnosis were identified. First-line outpatient VTE pharmacological treatment and factors independently associated with receipt/non-receipt of LMWH monotherapy were assessed.

Results.

Overall, 25% of the 1,089 eligible patients received LMWH monotherapy as primary VTE treatment. The percentage increased steadily over time from 18% among patients diagnosed in 2000 to 31% among those diagnosed in 2007. Factors associated with LMWH monotherapy included VTE diagnosis year, chemotherapy within 60 days prior to VTE diagnosis, history of VTE prior to cancer diagnosis, and invasive surgery in the 90 days following VTE diagnosis. Colorectal and prostate cancer patients versus lung cancer patients and stage III versus stage IV patients were less likely to be treated with LMWH monotherapy.

Conclusions.

Adoption of LMWH monotherapy as initial treatment for cancer-associated VTE was low but increased steadily over the study period. Future studies should explore reasons underlying the underutilization of this preferred evidence-based treatment as well as the comparative effectiveness of LMWH versus warfarin-based anticoagulation in real-world cancer patients with VTE.     

Cancer et récidive thromboembolique veineuse : non-respect des recommandations de traitement

Low-molecular-weight heparins (LMWH) are the reference curative treatment of venous thromboembolism (VTE) in patients with cancer. All international guidelines recommend the long-term use of LMWH given their demonstrated superiority compared to vitamin-K antagonists (VKA) in reducing VTE recurrence in this patient population without increased risk of bleeding. However, several studies consistently show a lack of adherence to treatment recommendations, which are applied at the very best in 50% of cases. This results in a loss of chance for patients with fragile prognosis and in whom VTE represents the second cause of death. Given the expected benefit and the increased VTE prevalence in patients with cancer, full awareness is necessary to implement programs aiming at improving the therapeutic management of cancer-associated VTE. This requires multidisciplinary consideration by qualified physicians involved in the management of patients with cancer-associated VTE such as oncologists, internists and those specialized in vascular disease and hemostasis.     

Treatment of cancer-associated venous thromboembolism in the age of direct oral anticoagulants

Anticoagulation for cancer-associated venous thromboembolism (VTE) can be challenging due to complications—including bleeding and potential drug–drug interactions with chemotherapy—associated with vitamin K antagonists and inconvenience of low-molecular-weight heparin (LMWH). Direct oral anticoagulants (DOACs) could partially overcome these issues, but until recently there were no large clinical trials assessing their efficacy and safety in cancer patients. This review summarizes clinical treatment guidelines, prior clinical and real-world evidence for anticoagulant choice, recent clinical trials assessing DOACs for cancer-associated VTE (i.e. Hokusai-VTE Cancer, SELECT-D, CARAVAGGIO, and ADAM VTE), and special considerations for DOAC use. Based on established data, clinical guidelines recommend patients with cancer-associated VTE receive LMWH treatment of at least 3–6 months. Nevertheless, LMWH is underused and associated with poor compliance and persistence in these patients relative to oral anticoagulants. Clinical data supporting DOAC use in cancer patients are becoming available. In Hokusai-VTE Cancer, edoxaban was noninferior to dalteparin for the composite of recurrent VTE and major bleeding (12.8% versus 13.5%), with numerically lower recurrent VTE (7.9% versus 11.3%) and significantly higher major bleeding (6.9% versus 4.0%); only patients with gastrointestinal cancer had significantly higher risk of bleeding with edoxaban. In SELECT-D, rivaroxaban had numerically lower VTE recurrence (4% versus 11%), comparable major bleeding (6% versus 4%), and numerically higher clinically relevant nonmajor bleeding (13% versus 4%) versus dalteparin. Most bleeding events were gastrointestinal or urologic; patients with esophageal/gastroesophageal cancer had higher rates of major bleeding with rivaroxaban (36% versus 11%). For comparison of apixaban versus dalteparin, CARAVAGGIO is ongoing, and preliminary results from ADAM VTE are favorable. This review concludes that DOACs appear to be reasonable alternatives to LMWH for treatment of cancer-associated VTE. In patients with gastrointestinal cancer, DOAC use should be considered on a case-by-case basis with consideration of the relative risks and benefits.     

The NCCN Clinical Practice Guidelines on Venous Thromboembolic Disease: strategies for improving VTE prophylaxis in hospitalized cancer patients

The risk for venous thromboembolism (VTE) is high in hospitalized cancer patients, and is associated with an elevated risk for recurrent thrombosis, bleeding complications, and use of health care resources. Thromboembolism is the second leading cause of death in hospitalized cancer patients. Thromboprophylaxis with unfractionated heparin or low-molecular-weight heparins has been clinically proven to reduce the risk for VTE and improve outcomes. However, VTE prophylaxis continues to be underprescribed in cancer patients. Recognizing the clinical burden of VTE in cancer patients, the National Comprehensive Cancer Network (NCCN) recently released guidelines for VTE prevention and management. These NCCN guidelines recommend evidence-based prophylactic anticoagulant therapy for all patients admitted to hospital with a diagnosis of cancer who do not have contraindications to anticoagulant use. However, there continue to be barriers to the implementation of clinical practice guidelines and appropriate use of VTE prophylaxis. Multifaceted active educational and electronic interventions are necessary to raise awareness and reduce the burden of cancer-associated thrombosis and its attendant consequences.     

基因突变状态与肿瘤相关性静脉血栓关系的研究进展

肿瘤相关性静脉血栓栓塞疾病（venous thromboembolic disease，VTE）已成为当下肿瘤患者的第二大死因，诸多学者提出多种血栓风险模型，从而筛选出血栓发生风险可能较高的患者进行药物及物理干预措施，减少肿瘤相关性VTE的发生。随着精准医学的不断发展，现有结论已不能满足医务人员探索肿瘤相关性VTE相关问题的要求。基因检测已经成为肿瘤患者的“基线”检查，检测常见的驱动基因如表皮生长因子受体（epidermal growth factor receptor，EGFR）、间变性淋巴瘤激酶（anaplastic lymphoma kinase，ALK）、v-ros UR2肉瘤病毒癌基因同源物1（v-ros UR2 sarcoma virus oncogene homolog 1，ROS1）和鼠类肉瘤病毒致癌基因（kirsten ras sarcoma，KRAS）等已成为常态且被指南推荐应用于临床，基因突变状态在影响临床预后和治疗决策方面的地位日益凸显。基因突变状态与肿瘤相关性VTE之间是否存在关联，可否根据基因状态筛选出具有较高血栓风险的癌症人群，从而为更好地实施预防管理策略提供理论基础。本文旨在对基因突变状态与肿瘤相关性VTE之间关系的研究进展及其潜在机制进行综述。      

肿瘤患者VTE风险评估模型的研究进展

静脉血栓栓塞（venous thromboembolism,VTE）已经成为肿瘤患者最常见的并发症,且成为除肿瘤患者外第二大死因。肿瘤本身是一种存在血栓和出血双风险并存的状态,对患者能够进行有效风险评估筛查的模型显得尤为关键。只有能在对肿瘤患者进行精准的风险分层,低风险患者能够不进行血栓预防或仅进行机械预防降低治疗成本和出血风险,高风险患者预防血栓中获益。本文对目前肿瘤并发相关VTE的情况、当前VTE风险评估模型的对比、风险模型的建立及未来发展方向进行探讨,旨在提高对相关VTE风险评估模型的的认识,并对风险模型的建立和发展提出理论支持。      

Cancer and thrombosis: implications of published guidelines for clinical practice

Cancer is a frequent finding in patients with thrombosis, and thrombosis is much more prevalent in patients with cancer, with important clinical consequences. Thrombosis is the second most common cause of death in cancer patients. Venous thromboembolism (VTE) in cancer is also associated with a high rate of recurrence, bleeding, a requirement for long-term anticoagulation, and worsened quality of life. Risk factors for cancer-associated VTE include particular cancer types, chemotherapy (with or without antiangiogenic agents), the use of erythropoietin-stimulating agents, the presence of central venous catheters, and surgery. Novel risk factors include platelet and leukocyte counts and tissue factor. A risk model for identifying cancer patients at highest risk for VTE has recently been developed. Anticoagulant therapy is safe and efficacious for prophylaxis and treatment of VTE in patients with cancer. Available anticoagulants include warfarin, heparin, and low-molecular weight heparins (LMWHs). LMWHs represent the preferred therapeutic option for VTE prophylaxis and treatment. Their use may be associated with improved survival in cancer, although this issue requires further study. Despite the significant burden imposed by VTE and the availability of effective anticoagulant therapies, many oncology patients do not receive appropriate VTE prophylaxis as recommended by practice guidelines. Improved adherence to guidelines could substantially reduce morbidity, decrease resource use, enhance quality of life, and improve survival in these patients.     

Thromboembolische Komplikationen – Prophylaxe und Therapie im Fokus

Cancer patients are at increased risk of thromboembolic complications, which are commonly referred to as Trousseau’s syndrome. Besides the potentially dramatic effects of the tumor on the coagulation and fibrinolytic systems, various supportive measures and more specific cancer treatments, such as surgery or chemotherapy contribute to the pathophysiology of cancer-associated venous thromboembolism (VTE). Clinical trials have shown that long-term therapy with low-molecular-weight heparin (LMWH) is superior to secondary prophylaxis with vitamin K antagonists in the treatment of patients with cancer-associated VTE. Based on currently available clinical evidence it is not clear which cancer patient should be offered primary thromboprophylaxis with LMWH. In this respect, the individual risk profile which is substantially influenced by the general condition of the patient and possible co-morbidities have to be taken into account. Recent experimental and clinical studies have suggested that LMWH affects tumor biology at various levels and may thus be potentially beneficial as an adjunct in cancer therapy.     

肿瘤并发静脉血栓形成196例临床分析

背景与目的：静脉血栓形成(venous thromboembolism,VTE)是恶性肿瘤患者的第二常见死亡原因。通过了解复旦大学附属肿瘤医院5年间收治的患者VTE的发病情况,分析VTE的相关特点,以提高肿瘤合并VTE的诊断和防治意识,改善患者预后。方法：对复旦大学附属肿瘤医院2009年7月-2014年6月收治的196例肿瘤并发VTE的患者的临床资料进行回顾性分析。分析肿瘤并发VTE的临床特点及发病情况,了解相关因素对VTE发病的影响,了解VTE首发情况。结果：复旦大学附属肿瘤医院5年间共收治肿瘤患者207 514例,其中VTE患者196例,肿瘤并发VTE发生率为0.94‰。腺癌在妇科肿瘤(56.5%)、胃肠道肿瘤(91.7%)、肺癌(71.4%)和胰腺癌(80%)中所占比例较高。单变量Logistic回归分析显示,腺癌为肿瘤患者并发肺栓塞(pulmonary embolism,PE)的高危险因素(OR=0.36,95%CI：0.146~0.885,P=0.026)。化疗大于2次者明显比化疗小于等于2次者VTE的发生率更高(χ²=10.976,P=0.001)。手术组VTE发生率高于非手术组。妇科肿瘤中有大量腹水者的非手术患者并发VTE者(>2 000 mL)更多(34.1% vs 10.7%,P=0.015)。术后和放化疗期间78%~88%的患者因出现深静脉血栓(deep vein thrombosis,DVT)症状发现VTE,而术前检查期间主要是在下肢静脉加压超声(compression venous ultrasonography,CUS)检查发现(59.1%)。复旦大学附属肿瘤医院术后进行物理性预防血栓措施者为15例(13.9%)。结论：复旦大学附属肿瘤医院的肿瘤相关性VTE发生率较其他流行病学调查发生率低。肿瘤患者术后并发VTE的风险明显高于非手术者。腺癌更易并发PE。对于临床无VTE症状的肿瘤患者和大量腹水的妇科肿瘤患者应积极进行VTE的相关检查,术后应更积极采取物理抗栓措施。     

Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers - Review

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.