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Figures
- Figure 1
Approach to the treatment of acute venous thromboembolism in patients with cancer.
DOACs = direct oral anticoagulants; LMWH = low-molecular-weight heparin
Data from references 11,16,32,36,39–43.
Tables
Guidelines Drugs Treatment American Society of Clinical Oncology LMWH, fondaparinux, rivaroxaban, edoxaban, vitamin K antagonists Initial (5–10 days): If parenteral anticoagulation used, LMWH preferred over unfractionated heparin
Long-term (at least 6 months): LMWH, rivaroxaban, edoxaban
DOACs: Caution with mucosal abnormalities, gastrointestinal and genitourinary cancers
Vitamin K antagonists: If DOACs or LMWH unavailable
Continue anticoagulation (beyond 6 months) in patients with active cancer such as metastatic disease, ongoing chemotherapyInternational Society on Thrombosis and Haemostasis Edoxaban, rivaroxaban, LMWH DOACs: Acute VTE, low risk of bleeding and no drug interaction with ongoing systemic therapy
LMWH/unfractionated heparin: Acute VTE, severe thrombocytopenia
Shared decision-making regarding reduction in recurrence of VTE compared with higher bleeding risk with specific DOACs and patient preferenceInternational Initiative on Thrombosis and Cancer LMWH, edoxaban, rivaroxaban, apixaban Initial treatment: LMWH recommended over unfractionated heparin or fondaparinux, DOACs as alternative
Early maintenance (6 months): LMWH preferred over vitamin K antagonists
Caution with DOACs in patients with gastrointestinal malignancy
Long-term maintenance (beyond 6 months): Evaluate based on benefit-risk ratio, tolerability, and patient preferenceAmerican Society of Hematology LMWH, apixaban, rivaroxaban, edoxaban Initial treatment (first week): LMWH or rivaroxaban or apixaban
Caution with DOACs in gastrointestinal malignancy, unfractionated heparin preferred over LMWH in renal insufficiency, creatinine clearance ≤ 30 mL/min
Short-term treatment (3–6 months): DOACs (apixaban, rivaroxaban, edoxaban) preferred over LMWH
DOACs: Caution in patients with gastrointestinal cancers, bleeding risks, drug interactions, cost
Vitamin K antagonists preferred in renal insufficiency
Long-term treatment (> 6 months): Recommended in patients with active cancer and absence of contraindications, DOACs or LMWHDOACs = direct oral anticoagulants; LMWH = low-molecular-weight heparin
Data from references 11,27,39–43.
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