ASCO GUIDELINES Bundle

Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer

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2 Key Points ➤ Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important cause of morbidity and mortality among patients with cancer. ➤ Patients with cancer are significantly more likely to develop VTE than people without cancer and experience higher rates of VTE recurrence and bleeding complications during VTE treatment. ➤ Comprehensive management of VTE in patients with cancer includes both the identification of patients who are most likely to benefit from pharmacologic prophylaxis, as well as effective treatment to reduce the risk of VTE recurrence and mortality. ➤ 1.1. Hospitalized patients who have active malignancy and acute medical illness or reduced mobility should be offered pharmacologic thromboprophylaxis in the absence of bleeding or other contraindications. (Moderate Recommendation; EB-I) ➤ 1.2. Hospitalized patients who have active malignancy without additional risk factors may be offered pharmacologic thromboprophylaxis in the absence of bleeding or other contraindications. (Moderate Recommendation; EB-L) ➤ 1.3. Routine pharmacologic thromboprophylaxis should not be offered to patients admitted for the sole purpose of minor procedures or chemotherapy infusion, nor to patients undergoing stem-cell/bone marrow transplantation. (Moderate Recommendation; IC-Ins) ➤ 2.1. Routine pharmacologic thromboprophylaxis should not be offered to all cancer outpatients. (Strong Recommendation; EB-I/H) ➤ 2.2. High-risk outpatients with cancer (Khorana score [Table 2] ≥2 prior to starting a new systemic chemotherapy regimen) may be offered thromboprophylaxis with apixaban, rivaroxaban or low- molecular-weight heparin (LMWH) provided there are no significant risk factors for bleeding and no drug interactions. Consideration of such therapy should be accompanied by a discussion with the patient about the relative benefits and harms, drug cost, and duration of prophylaxis in this setting. (Moderate Recommendation; EB-I/H for apixaban and rivaroxaban EB-I for LMWH) Treatment

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