title: Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update.
abstract: OBJECTIVE
  To provide recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. Prophylaxis in the outpatient, inpatient, and perioperative settings was considered, as were treatment and use of anticoagulation as a cancer-directed therapy.
  
  
  METHODS
  A systematic review of the literature published from December 2007 to December 2012 was completed in MEDLINE and the Cochrane Collaboration Library. An Update Committee reviewed evidence to determine which recommendations required revision.
  
  
  RESULTS
  Forty-two publications met eligibility criteria, including 16 systematic reviews and 24 randomized controlled trials.
  
  
  CONCLUSIONS
  Most hospitalized patients with cancer require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for outpatients with cancer. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low-molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major cancer surgery should receive prophylaxis, starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term (6 months) secondary prophylaxis. Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE. Anticoagulation should not be used for cancer treatment in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should provide patient education about the signs and symptoms of VTE.
authors.affiliation: Duke University and Duke Cancer Institute, Durham, NC, USA.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: Alok A
authors.initials: AA
authors.lastname: Khorana
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Kuderer
authors.forename: Agnes Y
authors.initials: AY
authors.lastname: Lee
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: Arcelus
authors.forename: Edward P
authors.initials: EP
authors.lastname: Balaban
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Clarke
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.forename: Charles W
authors.initials: CW
authors.lastname: Francis
authors.forename: Leigh E
authors.initials: LE
authors.lastname: Gates
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Kakkar
authors.forename: Nigel S
authors.initials: NS
authors.lastname: Key
authors.forename: Mark N
authors.initials: MN
authors.lastname: Levine
authors.forename: Howard A
authors.initials: HA
authors.lastname: Liebman
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Tempero
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.forename: Ann Alexis
authors.initials: AA
authors.lastname: Prestrud
authors.forename: Anna
authors.initials: A
authors.lastname: Falanga
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000097:blood*; D018570:Risk Assessment; D014481:United States; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*