PAPERSWomen, thrombosis, and cancer: A gender-specific analysis

ABSTRACTVenous thromboembolism (VTE) is a major common complication in cancer patients. Risk-adapted thromboprophylaxis and antithrombotic therapy for patients diagnosed with VTE can reduce the recurrence of VTE events. Thrombotic risk varies according to cancer type, stage, and comorbidities. The current review analyzes most recent data and provides clinical guidance for the management of women with cancer-associated thrombosis.Highlights
- Evidence-based clinical practice guidelines do not distinguish between men and women in their recommendations for VTE treatment and prophylaxis in cancer, but special considerations are sometimes required in women
- For post-menopausal women with breast cancer who require hormone therapy for prevention of ER-positive cancer recurrence, aromatase inhibitors can be considered as a treatment alternative to tamoxifen to reduce VTE risk
- Women with gynecological malignancies are at high risk of developing VTE, but anticoagulant treatment is currently underprescribed in these patients
- Women's health issues such as contraception, pregnancy, and fertility preservation increase the risk of VTE
- In pregnant patients with VTE and cancer, treatments need to be individualized based on cancer characteristics, gestational stage, and the mother's wishes. Low-molecular-weight heparins are recommended for the treatment of VTE in pregnant women because they do not cross the blood brain barrier, but vitamin K antagonists and direct oral anticoagulants are currently contraindicated
- Routine VTE prophylaxis is not indicated in cancer patients who undergo fertility preservation, but may be appropriate in women who develop early ovarian hyperstimulation syndrome