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
