Guidelines for treatment of venous thromboembolism (VTE) in patients with cancer
| 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 chemotherapy |
| International 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 preference |
| International 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 preference |
| American 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 LMWH |
DOACs = direct oral anticoagulants; LMWH = low-molecular-weight heparin
Data from references 11,27,39–43.