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Table 2 Comparison of recommendations regarding treatment of established cancer-associated VTE between the latest ASCO [5] and ITAC [2] guidelines

From: Current status of treatment of cancer-associated venous thromboembolism

Duration Initial treatment (typically first 5–10 days) + long-term treatment (6 months) + treatment after 6 months Initial treatment (typically first 5–10 days) + early maintenance (6 months) + long-term treatment (6 months later)
Treatment within 6 months
 1. Agents LMWH (twice-daily preferred) or UFH or fondaparinux or DOACs is recommended when CrCl is ≥30 mL/min LMWH (once-daily preferred) or DOACs or UFH or fondaparinux is recommended when CrCl is ≥30 mL/min
 2. Thrombolysis Not mentioned Only for patients without contraindications on a case-by-case basis (CDT considered)
 3. IVCF Only for patients with life-threatening VTE and absolute contraindications to anticoagulation (retrievable filter preferred) May be considered for patients with contraindications to anticoagulation
Treatment after 6 months The use of LMWH or DOACs or VKA should be offered to active cancer patients with intermittent risk-benefit reassessment The use of LMWH or DOACs or VKA should be based on individual evaluation of the benefit–risk, tolerability, drug availability, patient preference, and cancer activity
Catheter-related VTE Not mentioned LMWH is recommended for a minimum of 3 months and as long as the CVC is in place
Recurrent VTE
 1. Anticoagulant regimen Switching to an alternative anticoagulant regimen or increasing the dose of LMWH may be considered For LMWH, increase the dose by 20–25% or switch to DOACs; for DOACs, switch to LMWH; for VKA, switch to LMWH or DOACs
 2. IVCF May be offered to patients with progression of thrombosis despite optimal anticoagulation as a last resort (retrievable filter preferred) May be considered for patients with recurrent pulmonary embolism despite optimal anticoagulation
Incidental VTE Treated in the same manner as symptomatic VTE Not mentioned
Subsegmental PE or SPVT Treatment should be offered on a case-by-case basis Not mentioned
  1. Note: VTE Venous thromboembolism, ASCO American Society of Clinical Oncology, ITAC International Initiative on Thrombosis and Cancer, LMWH Low-molecular-weight heparin, UFH Unfractionated heparin, DOACs Direct oral anticoagulants, CrCl Creatinine clearance, CDT Catheter directed thrombolysis, IVCF Inferior vena cava filter, VKA Vitamin K antagonist, CVC Central venous catheter, PE Pulmonary embolism, SPVT Splanchnic vein thrombosis