3
➤ 2.3. Patients with multiple myeloma receiving thalidomide-
or lenalidomide-based regimens with chemotherapy and/or
dexamethasone should be offered pharmacologic thromboprophylaxis
with either aspirin or LMWH for lower-risk patients and LMWH for
higher-risk patients. (Strong Recommendation; EB-I)
➤ 3.1. All patients with malignant disease undergoing major surgical
intervention should be offered pharmacologic thromboprophylaxis
with either unfractionated heparin (UFH) or LMWH unless
contraindicated because of active bleeding, or high bleeding risk, or
other contraindications. (Strong Recommendation; EB-H)
➤ 3.2. Prophylaxis should be commenced preoperatively. (Moderate
Recommendation; EB-I)
➤ 3.3. Mechanical methods may be added to pharmacologic
thromboprophylaxis but should not be used as monotherapy for
VTE prevention unless pharmacologic methods are contraindicated
because of active bleeding or high bleeding risk. (Strong
Recommendation; EB-I)
➤ 3.4. A combined regimen of pharmacologic and mechanical
prophylaxis may improve efficacy, especially in the highest-risk
patients. (Moderate Recommendation; EB-I)
➤ 3.5. Pharmacologic thromboprophylaxis for patients undergoing
major surgery for cancer should be continued for at least 7–10 days.
Extended prophylaxis with LMWH for up to 4 weeks postoperatively
is recommended for patients undergoing major open or laparoscopic
abdominal or pelvic surgery for cancer who have high-risk features
such as restricted mobility, obesity, history of VTE, or with
additional risk factors. In lower-risk surgical settings, the decision
on appropriate duration of thromboprophylaxis should be made on a
case-by-case basis. (Strong Recommendation; EB-H)
➤ 4.1. Initial anticoagulation may involve LMWH, UFH, fondaparinux,
or rivaroxaban. For patients initiating treatment with parenteral
anticoagulation, LMWH is preferred over UFH for the initial 5–10 days
of anticoagulation for the patient with cancer with newly diagnosed
VTE who does not have severe renal impairment (defined as
creatinine clearance <30 mL/min). (Strong Recommendation; EB-H)
Treatment