American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer.
OBJECTIVE
To develop guideline recommendations for the use of anticoagulation in the prevention and treatment of venous thromboembolism (VTE) in patients with cancer.


METHODS
A comprehensive systematic review of the medical literature on the prevention and treatment of VTE in cancer patients was conducted and reviewed by a panel of content and methodology experts. Following discussion of the results, the panel drafted recommendations for the use of anticoagulation in patients with malignant disease.


RESULTS
The results of randomized controlled trials of primary and secondary VTE medical prophylaxis, surgical prophylaxis, VTE treatment, and the impact of anticoagulation on survival of patients with cancer were reviewed. Recommendations were developed on the prevention of VTE in hospitalized, ambulatory, and surgical cancer patients as well as patients with established VTE, and for use of anticoagulants in cancer patients without VTE to improve survival.


CONCLUSIONS
Recommendations of the American Society of Clinical Oncology VTE Guideline Panel include (1) all hospitalized cancer patients should be considered for VTE prophylaxis with anticoagulants in the absence of bleeding or other contraindications; (2) routine prophylaxis of ambulatory cancer patients with anticoagulation is not recommended, with the exception of patients receiving thalidomide or lenalidomide; (3) patients undergoing major surgery for malignant disease should be considered for pharmacologic thromboprophylaxis; (4) low molecular weight heparin represents the preferred agent for both the initial and continuing treatment of cancer patients with established VTE; and (5) the impact of anticoagulants on cancer patient survival requires additional study and cannot be recommended at present.
Lyman
Gary H
GH
Duke University Medical Center, University of Rochester Medical Center, Rochester, USA.
Khorana
Alok A
AA
Falanga
Anna
A
Clarke-Pearson
Daniel
D
Flowers
Christopher
C
Jahanzeb
Mohammad
M
Kakkar
Ajay
A
Kuderer
Nicole M
NM
Levine
Mark N
MN
Liebman
Howard
H
Mendelson
David
D
Raskob
Gary
G
Somerfield
Mark R
MR
Thodiyil
Paul
P
Trent
David
D
Francis
Charles W
CW
D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*
D000925:Anticoagulants