5
➤ 4.7. Incidental pulmonary embolism and deep vein thrombosis
should be treated in the same manner as symptomatic VTE, given
their similar clinical outcomes compared to cancer patients with
symptomatic events. (Moderate Recommendation; IC-L)
➤ 4.8. Treatment of isolated subsegmental pulmonary embolism or
splanchnic or visceral vein thrombi diagnosed incidentally should be
offered on a case-by-case basis, considering potential benefits and
risks of anticoagulation. (Moderate Recommendation; IC-Ins)
➤ 5. Anticoagulant use is not recommended to improve survival in
patients with cancer without VTE. (Strong Recommendation; EB-H)
➤ 6.1. There is substantial variation in risk of VTE between individual
cancer patients and cancer settings. Patients with cancer should be
assessed for VTE risk initially and periodically thereafter, particularly
when starting systemic antineoplastic therapy or at the time of
hospitalization. Individual risk factors, including biomarkers or
cancer site, do not reliably identify patients with cancer at high risk
of VTE. In the ambulatory setting among patients with solid tumors
treated with systemic therapy, risk assessment can be conducted
based on a validated risk assessment tool (Khorana score, Table 2).
(Strong Recommendation; EB-I)
➤ 6.2. Oncologists and members of the oncology team should educate
patients regarding VTE, particularly in settings that increase risk
such as major surgery, hospitalization, and while receiving systemic
antineoplastic therapy. (Strong Recommendation; IC-Ins)
Notes regarding off-label use in guideline recommendations: Apixaban, rivaroxaban, and
LMWH have not been FDA approved for thromboprophylaxis in outpatients with cancer
(recommendation 2.2 for apixaban and rivaroxaban; recommendations 2.2 and 2.3 for
LMWH). Dalteparin is the only LMWH with FDA approval for extended therapy to prevent
recurrent thrombosis in patients with cancer (recommendation 4.2).
