Table 2 Summary of guideline recommendations for CA-VTE treatment and thromboprophylaxis in patients with cancer
Guideline | Year | CA-VTE Treatment | Thromboprophylaxis | |
|---|---|---|---|---|
Preferred or first-line option | Alternative or second-line options | |||
ISTH [27] | 2018 | If low risk of bleeding and no drug–drug interactions: DOACs | LMWH | NA |
ESC [10] | 2019 | LMWH | Edoxaban or rivaroxaban | NA |
ASCO [20] | 2019 | Initial treatment: LMWH, UFH, fondaparinux, or rivaroxaban Up to six months: LMWH, edoxaban, or rivaroxaban Long term anticoagulation: LMWH, DOAC, or VKA | If unable to obtain LMWH, edoxaban, or rivaroxaban: VKA | High-risk ambulatory patients (Khorana score ≥ 2): LMWH, apixaban, or rivaroxaban |
NCCN [28] | 2020 | Patients without gastric or gastrointestinal lesions: Apixaban, rivaroxaban, or edoxaban Patients with gastric or gastrointestinal lesions: Dalteparin or enoxaparin | Dabigatran (with LMWH or UFH for at least 5 days), fondaparinux, UFH, or warfarin | High risk ambulatory patients (Khorana score ≥ 2): Apixaban or rivaroxaban |
ITAC [21] | 2020 | Initial treatment and for up to six months: • if CrCl ≥ 30 mL/min: LMWH • if CrCl ≥ 30 mL/min, patient has low risk of GI or genitourinary bleeding, and no drug–drug interactions: Edoxaban, or rivaroxaban | If no contraindications: Fondaparinux If patient has contraindication for LMWH or DOACs: UFH | If hospitalized with reduced mobility and CrCl ≥ 30 mL/min: LMWH or fondaparinux, or UFH For patients with pancreatic cancer or Khorana score ≥ 2 while receiving systemic anticancer therapy at intermediate-to-high risk of VTE and not actively, or at a high-risk of, bleeding: Rivaroxaban, apixaban, or LMWH Immunomodulatory drugs combined with steroids or other systemic anticancer therapies: VKA (at low or therapeutic dose), LMWH, or low-dose aspirin |
ASH [19] | 2021 | Initial treatment: LMWH Up to six months: DOACs Long term anticoagulation: DOACs or LMWH | If patient has contraindication for LMWH or DOACs: UFH | If hospitalized: LMWH High risk ambulatory patients receiving systemic therapy: Rivaroxaban or apixaban |
CHEST [22] | 2021 | DOACs | LMWH | NA |