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Table 4 Comparison of Recommendations Regarding Anticoagulation of Cancer-associated VTE in Special Situations Between the Latest ASCO [5] and ITAC [2] Guidelines

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

  ASCO ITAC
Intracranial Malignancy DOACs or LMWH should be offered to patients with established VTE and primary or metastatic CNS malignancies LMWH or DOACs should be recommended for patients with established VTE and brain tumor or cancer patients undergoing neurosurgery
Thrombocytopenia Anticoagulation is absolutely contraindicated when platelet count is persistently below 20 × 109/L, and relatively contraindicated when platelet count is persistently below 50 × 109/L For established VTE, full doses of anticoagulant can be used when platelet count is>50 × 109/L and should be deliberated case-by-case when platelet count is≤50 × 109/L; prophylactic anticoagulation can be used when platelet count is>80 × 109/L
Renal impairment For moderate to severe renal impairment, LMWH adjusted to anti-Xa level or UFH followed by VKA are recommended When CrCl is < 30 mL/min, UFH followed by VKA or LMWH adjusted to anti-Xa level are recommended; an external compression device can be applied
Obesity For obese cancer patients (BMI>40 kg/m2 or a weight>120 kg), LMWH is preferred over DOACs; the monitoring of drug-specific peak and trough levels are advised if DOACs used A higher dose of LMWH should be offered for obese cancer patients undergoing surgery
Pregnancy Not mentioned LMWH is recommended; VKA and DOACs should be avoided
  1. Note: VTE Venous thromboembolism, ASCO American Society of Clinical Oncology, ITAC International Initiative on Thrombosis and Cancer, DOACs Direct oral anticoagulants, LMWH Low-molecular-weight heparin, CNS Central nervous system, CrCl Creatinine clearance, UFH Unfractionated heparin, VKA Vitamin K antagonist, BMI Body mass index