What are the international guidelines for the prevention and treatment of venous thromboembolism (VTE) in cancer patients?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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International clinical practice guidelines for the treatment and prophylaxis of VTE in patients with cancer were issued in early 2013. [29] Recommendations included the following:

  • For the initial treatment of established VTE, LMWH is recommended, and fondaparinux and UFH can be also used
  • Thrombolysis may only be considered on a case-by-case basis
  • Vena cava filters (VCFs) may be considered if there is a contraindication to anticoagulation or PE recurrence under optimal anticoagulation
  • Periodic reassessments of contraindications to anticoagulation are recommended
  • VCFs are not recommended for primary VTE prophylaxis in cancer patients
  • For the early maintenance and long-term treatment of established VTE, LMWH for a minimum of 3 months is preferred over vitamin K antagonists (VKAs). Idraparinux is not recommended. After 3-6 months, LMWH or VKA continuation should be based on individual evaluation of the benefits and risks, tolerability, patient preference and cancer activity
  • For the treatment of VTE recurrence in cancer patients receiving anticoagulation, there are three options: (i) switch from VKA to LMWH when treated with VKA; (ii) increase LMWH dose when treated with LMWH, and (iii) VCF insertion
  • For the prophylaxis of postoperative VTE in surgical cancer patients, use of LMWH or low-dose UFH is recommended
  • Extended prophylaxis (4 weeks) after major laparotomy may be indicated in patients with a high risk of VTE and low risk of bleeding
  • Use of LMWH for VTE prevention in cancer patients undergoing laparoscopic surgery may be recommended as for laparotomy
  • Mechanical methods are not recommended as monotherapy except when pharmacologic methods are contraindicated
  • In hospitalized patients with cancer and reduced mobility, prophylaxis with LMWH, UFH, or fondaparinux is recommended
  • Prophylaxis may be considered in some children and adults with acute lymphocytic leukemia treated with L-asparaginase, depending on local policy and patient characteristics
  • Routine prophylaxis is not recommended in patients receiving chemotherapy
  • Primary pharmacologic prophylaxis of VTE may be indicated in patients with locally advanced or metastatic pancreatic or lung cancer treated with chemotherapy and having a low risk of bleeding
  • In patients treated with thalidomide or lenalidomide combined with steroids and/or chemotherapy, VTE prophylaxis is recommended

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