Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

This provides recommendations about prophylaxis and treatment of venous thromboembolism in patients with cancer. Prophylaxis in the outpatient, inpatient, and perioperative settings is considered, as is treatment and use of anticoagulation as a cancer-directed therapy.

The updated guideline provides 10 key recommendations:

 

• Most hospitalised patients with cancer require thromboprophylaxis throughout hospitalisation.

• Thromboprophylaxis is not routinely recommended for outpatients with cancer. It may be considered for selected high-risk patients.

• Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low molecular weight heparin (LMWH) or low-dose aspirin to prevent VTE.

• Patients undergoing major cancer surgery should receive prophylaxis, starting before surgery and continuing for at least seven to 10 days.

• Extending prophylaxis up to four weeks should be considered in those with high-risk features.

• LMWH is recommended for the initial five to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term (six months) secondary prophylaxis.

• Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE.

• Anticoagulation should not be used for cancer treatment in the absence of other indications.

• Patients with cancer should be periodically assessed for VTE risk.

• Oncology professionals should provide patient education about the signs and symptoms of VTE.

 

NICE offers general recommendations on VTE prophylaxis for patients with cancer who are admitted to hospital in its clinical guideline on reducing the risk of VTE (CG92; issued Jan 2010).