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Table 3 Comparison of Contraindications to Therapeutic Anticoagulant Therapy of Cancer-associated VTE Between the Latest NCCN [1] and ASCO [5] Guidelines

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

Absolute contraindications 1. Recent/acute HIT for LMWH or UFH
2. Severe renal dysfunction (CrCl < 30 mL/min) for fondaparinux or DOACs
3. Active/clinically significant liver disease for DOACs
4. Concomitant use of strong dual inhibitors/inducers of CYP3A4 and P-glycoprotein for DOACs
5. Concomitant use of inducers/inhibitors of P-glycoprotein for DOACs
1. Active major, serious, or potentially life-threatening bleeding
2. Severe, uncontrolled malignant hypertension
3. Severe, uncompensated coagulopathy
4. Severe platelet dysfunction or inherited bleeding disorder
5. Persistent, severe thrombocytopenia (<20 × 109/L)
6. High-risk invasive procedure in a critical site
7. Concurrent use of potent P-glycoprotein or CYP3A4 inhibitors or inducers for DOACs
Relative contraindications 1. Severe renal dysfunction (CrCl < 30 mL/min) for LMWH
2. Past history of HIT for LMWH or UFH
3. Moderate renal insufficiency (CrCl 30–50 mL/min), weight < 50 kg, or age > 75y for fondaparinux
4. Concomitant use of inhibitors/inducers of CYP2C9, 1A2, or 3A4 for VKA
5. Urinary or gastrointestinal tract lesions for DOACs
6. Compromised renal or liver function for DOACs
7. Patients receiving nephrotoxic or hepatotoxic chemotherapy for DOACs
8. Drug-drug interactions for DOACs
1. Intracranial or spinal lesion at high risk for bleeding
2. Active gastrointestinal ulceration at high risk of bleeding
3. Active but non–life-threatening bleeding
4. Intracranial or CNS bleeding within past 4 weeks
5. Recent high-risk surgery or bleeding event
6. Persistent thrombocytopenia (<50 × 109/L)
  1. Note: VTE Venous thromboembolism, NCCN National Comprehensive Cancer Network, ASCO American Society of Clinical Oncology, HIT Heparin-induced thrombocytopenia, LMWH Low-molecular-weight heparin, UFH Unfractionated heparin, CrCl Creatinine clearance, DOACs Direct oral anticoagulants, CYP Cytochrome P450, CNS Central nervous system, VKA Vitamin K antagonist