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

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)

 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

 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