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
| ASCO | ITAC | |
|---|---|---|
| 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 |