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BACKGROUND: Patients with renal cell carcinoma (RCC) and tumor thrombus (TT) are at significant risk of venous thromboembolism (VTE).

OBJECTIVES: This systematic review aimed to assess the role of anticoagulation in ambulatory patients with RCC and TT.

METHODS: Inclusion criteria were diagnosis of RCC with TT, reporting of VTE, major bleeding and/or arterial thromboembolism, as well as exposure to anticoagulation. Studies with <30 patients were excluded. Studies were also excluded if anticoagulation status was not reported per outcome stratum. A comprehensive search was conducted in PubMed and other databases. Risk of bias was assessed in accordance with the Scottish Intercollegiate Guidelines Network bias quality assessment tool.

RESULTS: Six observational studies containing 659 patients were included. All studies had considerable risk of bias. Anticoagulation use ranged from 3.9% to 50%. Two studies reported a lower VTE incidence in anticoagulated patients than in non-anticoagulated patients: 7.3% (1.2-21) vs 20% (6.9-37) after 1 year, and 18% (1.5-49) vs 24% (14-36) after 2 years. In anticoagulated patients, major bleeding incidence was 12% (2.8-27) after 1 year and 33% (8.2-60) after 2 years. For non-anticoagulated patients the incidence was 19% (6.6-36) after 1 year and 12% (5.1-22) after 2 years. Importantly, none of the studies were management studies, and confidence intervals of our outcomes were wide.

CONCLUSION: Anticoagulation in patients with RCC with TT may lower VTE risk. Bleeding risk is high in both anticoagulated as well as non-anticoagulated patients. Current evidence remains inconclusive due to study heterogeneity and risk of bias.

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