Arterial and venous thromboembolism

No increased incidence of venous thromboembolism in patients receiving VEGF-i therapy.
4.5% incidence of arterial thromboembolism (CVA, MI, unstable angina, transient ischemic attack, claudication, subarachnoid haemorrhage and other arterial embolic events). Risk of cardiac failure with TKIs.
Patients > 65 or with a previous history of arterial thromboembolic event at increased risk.
Use of low dose aspirin (<325 mg/day) seems safe. Prophylactic aspirin (75-150mg) may be considered for those at high risk of thromboembolism provided there are no contra-indications to its usage.

Management of thromboembolism during course of treatment with VEGF-i

Withhold VEGF-i for 2-3 weeks.
If stable and no haemorrhagic complication then resume VEGF-i once stable on anticoagulant.

Caution if previous history of arterial thromboembolic events especially if age over 65.
Do not treat with a VEGF-i within at least 6 months of an arterial thromboembolic event (myocardial infarction, TIA, cerebrovascular accident or other event). VEGF-i should be started only if stable and asymptomatic from this event.
Permanently stop VEGF-i if develop any arterial thromboembolic event during VEGF-i therapy.
Safe to treat with full-dose anticoagulant therapy – no apparent increased risk of bleeding.

Last reviewed: 05/01/2024

Next review date: 05/01/2027

Author(s): Edinburgh Cancer Centre.

Version: 1.1

Approved By: Authorised by CTAC. Refer to Q-Pulse for approval details.

Reviewer name(s): Stewart J.