Venous Thromboembolism Prophylaxis and Treatment in Cancer Patients Clinical Practice Guidelines (ASCO, 2019)

American Society of Clinical Oncology

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

October 04, 2019

Guidelines on venous thromboembolism (VTE) prophylaxis and treatment in cancer patients were released in August 2019 by the American Society of Clinical Oncology.[1,2]

VTE Prophylaxis in Hospitalized Cancer Patients

Patients with acute medical illness or reduced mobility and active malignancy should be offered anticoagulant medications unless bleeding or other contraindications exist.

Patients with active malignancy but no additional risk factors may be offered anticoagulant medications unless bleeding or other contraindications exist.

Patients (1) admitted for only a minor procedure or for chemotherapy infusion, (2) undergoing stem-cell transplantation, or (3) undergoing bone marrow transplantation should not be offered routine anticoagulant thromboprophylaxis.

VTE Prophylaxis in Ambulatory Cancer Patients With Ongoing Systemic Chemotherapy

Outpatients with cancer should not be offered routine anticoagulant thromboprophylaxis.

Outpatients considered high-risk based on a Khorana score of 2 or higher prior to initiation of a new systemic chemotherapy regimen may be offered anticoagulant thromboprophylaxis with rivaroxaban, apixaban, or low–molecular-weight heparin (LMWH) only if they do not have significant risk factors for bleeding and there are no known drug interactions. In this situation, relative benefits and risks, drug costs, and the duration of prophylaxis should be discussed with the patient.

Patients with multiple myeloma who are receiving lenalidomide- or thalidomide-based chemotherapy regimens and/or dexamethasone should be offered anticoagulant thromboprophylaxis with either LMWH or aspirin (for lower-risk patients) and LMWH (for higher-risk patients).

VTE Prophylaxis in Cancer Patients Undergoing Surgery

Patients with malignant disease who are undergoing major surgery should be offered anticoagulant thromboprophylaxis with LMWH or unfractionated heparin (UFH) unless contraindications exist owing to active bleeding, a high risk of bleeding, or other contraindications.

Prophylaxis should be started preoperatively.

Mechanical methods of thromboprophylaxis can be added to anticoagulant thromboprophylaxis, but mechanical methods should not be used alone unless contraindications exist for pharmacologic methods (eg, active bleeding, high risk of bleeding).

Prophylactic efficacy may be improved with the use of a combination of pharmacologic and mechanical methods, particularly in the highest-risk patients.

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