What are the ACCP treatment guidelines for pulmonary embolism (PE) in association with an active neoplasm?

Updated: Jun 06, 2019
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Patients who have PE in association with an active neoplasm provide challenges for long-term management because of their increased continuing risk for recurrent VTE and PE. The ninth edition of the ACCP guidelines recommends that such patients receive extended anticoagulation as opposed to three month therapy if they are at low or moderate risk of bleeding complications (grade 1B). [5] If patients with active neoplasm are at high risk of bleeding, it is still suggested that they receive extended therapy, though the supporting evidence is less conclusive (grade 2B). For the treatment of PE in cancer patients, LMWH is recommended in preference to a vitamin K antagonist such as warfarin (grade 2B). However, some cancer patients choose not to have long-term treatment with LMWH because of the need for daily injections and treatment costs. If cancer patients with PE choose not to have treatment with LMWH, a vitamin K antagonist such as warfarin is preferred over dabigatran or rivaroxaban (grade 2C).


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