Internal and Emergency Medicine

, Volume 14, Issue 1, pp 21–38 | Cite as

Position paper of the Italian Society of Internal Medicine (SIMI) on prophylaxis and treatment of venous thromboembolism in patients with cancer

  • Domenico Prisco
  • Antonella TufanoEmail author
  • Caterina Cenci
  • Pasquale Pignatelli
  • Francesca Santilli
  • Giovanni Di Minno
  • Francesco Perticone


Cancer patients are at high risk of developing thrombotic events, including venous thromboembolism (VTE) [deep venous thrombosis (DVT) and pulmonary embolism (PE)], and arterial thrombosis. DVT and PE represent the second leading cause of death in cancer patients; moreover, the development of thromboembolic events in cancer patients is linked to a greater need of hospitalization and frequency of side effects during treatment, in particular bleeding, and to an increased risk of recurrence during and following antithrombotic therapy. The thromboembolic risk may be different in different subgroups of cancer population, being highest in patients with metastatic disease, patients with pancreas, stomach, kidney or primary brain cancer, or during therapeutic interventions or surgery. This document focuses on several relevant topics including the epidemiology and pathogenesis of cancer-associated VTE, the current and future strategies of primary prevention and anticoagulant treatment, and the management of bleeding complications. The main literature data are discussed in detail, including, when available, evidence from randomized clinical trials and meta-analyses, international guidelines statements, the results of recently published trials comparing direct oral anticoagulants to low molecular weight heparin, and the design and aims of ongoing trials on prevention/treatment of cancer-associated VTE.


Venous thromboembolism Cancer Anticoagulant therapy Bleeding 


Compliance with ethical standards

Conflict of interest

DP declares fees for participations in editorial boards and lectures by Bayer, Boehringer Ingelheim, BMS-Pfizer and Daiichi Sankyo given to his Institution. PP declares speakers’ fees by Bayer, Boehringer Ingelheim, BMS-Pfizer and Daiichi Sankyo. FP declares fees for lectures by Bayer, Boehringer Ingelheim, BMS-Pfizer and Daiichi Sankyo. AT, CC, FS, GDM declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any study with human and animals performed by any of the authors.

Informed consent



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© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  1. 1.Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
  2. 2.Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders“Federico II” University HospitalNaplesItaly
  3. 3.Department of Internal Medicine and Medical SpecialtiesLa Sapienza University of RomeRomeItaly
  4. 4.Department of Medicine and Aging and Center of Aging Science and Translational Medicine (CESI-Met)“G. d’Annunzio” University of Chieti-PescaraChietiItaly
  5. 5.Department of Medical and Surgical Sciences“Magna-Græcia” University of CatanzaroCatanzaroItaly

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