Venous thromboembolism prophylaxis and treatment in patients with cancer

American Society of Clinical Oncology Clinical Practice Guideline Update

Gary H. Lyman, Alok A. Khorana, Nicole M. Kuderer, Agnes Y. Lee, Juan Ignacio Arcelus, Edward Balaban, Jeffrey M. Clarke, Christopher R. Flowers, Charles W. Francis, Leigh E. Gates, Ajay K. Kakkar, Nigel S. Key, Mark N. Levine, Howard A. Liebman, Margaret A. Tempero, Sandra L. Wong, Ann Alexis Prestrud, Anna Falanga

Research output: Contribution to journalReview article

533 Citations (Scopus)

Abstract

Purpose: 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. Recommendations: 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.

Original languageEnglish (US)
Pages (from-to)2189-2204
Number of pages16
JournalJournal of Clinical Oncology
Volume31
Issue number17
DOIs
StatePublished - Jun 10 2013

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Venous Thromboembolism
Practice Guidelines
Neoplasms
Low Molecular Weight Heparin
Therapeutics
Outpatients
Patient Education
Multiple Myeloma
Pulmonary Embolism
MEDLINE
Venous Thrombosis
Anticoagulants
Dexamethasone
Aspirin
Libraries
Signs and Symptoms
Publications
Inpatients
Hospitalization
Randomized Controlled Trials

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Lyman, Gary H. ; Khorana, Alok A. ; Kuderer, Nicole M. ; Lee, Agnes Y. ; Arcelus, Juan Ignacio ; Balaban, Edward ; Clarke, Jeffrey M. ; Flowers, Christopher R. ; Francis, Charles W. ; Gates, Leigh E. ; Kakkar, Ajay K. ; Key, Nigel S. ; Levine, Mark N. ; Liebman, Howard A. ; Tempero, Margaret A. ; Wong, Sandra L. ; Prestrud, Ann Alexis ; Falanga, Anna. / Venous thromboembolism prophylaxis and treatment in patients with cancer : American Society of Clinical Oncology Clinical Practice Guideline Update. In: Journal of Clinical Oncology. 2013 ; Vol. 31, No. 17. pp. 2189-2204.
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title = "Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update",
abstract = "Purpose: 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. Recommendations: 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.",
author = "Lyman, {Gary H.} and Khorana, {Alok A.} and Kuderer, {Nicole M.} and Lee, {Agnes Y.} and Arcelus, {Juan Ignacio} and Edward Balaban and Clarke, {Jeffrey M.} and Flowers, {Christopher R.} and Francis, {Charles W.} and Gates, {Leigh E.} and Kakkar, {Ajay K.} and Key, {Nigel S.} and Levine, {Mark N.} and Liebman, {Howard A.} and Tempero, {Margaret A.} and Wong, {Sandra L.} and Prestrud, {Ann Alexis} and Anna Falanga",
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Lyman, GH, Khorana, AA, Kuderer, NM, Lee, AY, Arcelus, JI, Balaban, E, Clarke, JM, Flowers, CR, Francis, CW, Gates, LE, Kakkar, AK, Key, NS, Levine, MN, Liebman, HA, Tempero, MA, Wong, SL, Prestrud, AA & Falanga, A 2013, 'Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update', Journal of Clinical Oncology, vol. 31, no. 17, pp. 2189-2204. https://doi.org/10.1200/JCO.2013.49.1118

Venous thromboembolism prophylaxis and treatment in patients with cancer : American Society of Clinical Oncology Clinical Practice Guideline Update. / Lyman, Gary H.; Khorana, Alok A.; Kuderer, Nicole M.; Lee, Agnes Y.; Arcelus, Juan Ignacio; Balaban, Edward; Clarke, Jeffrey M.; Flowers, Christopher R.; Francis, Charles W.; Gates, Leigh E.; Kakkar, Ajay K.; Key, Nigel S.; Levine, Mark N.; Liebman, Howard A.; Tempero, Margaret A.; Wong, Sandra L.; Prestrud, Ann Alexis; Falanga, Anna.

In: Journal of Clinical Oncology, Vol. 31, No. 17, 10.06.2013, p. 2189-2204.

Research output: Contribution to journalReview article

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T1 - Venous thromboembolism prophylaxis and treatment in patients with cancer

T2 - American Society of Clinical Oncology Clinical Practice Guideline Update

AU - Lyman, Gary H.

AU - Khorana, Alok A.

AU - Kuderer, Nicole M.

AU - Lee, Agnes Y.

AU - Arcelus, Juan Ignacio

AU - Balaban, Edward

AU - Clarke, Jeffrey M.

AU - Flowers, Christopher R.

AU - Francis, Charles W.

AU - Gates, Leigh E.

AU - Kakkar, Ajay K.

AU - Key, Nigel S.

AU - Levine, Mark N.

AU - Liebman, Howard A.

AU - Tempero, Margaret A.

AU - Wong, Sandra L.

AU - Prestrud, Ann Alexis

AU - Falanga, Anna

PY - 2013/6/10

Y1 - 2013/6/10

N2 - Purpose: 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. Recommendations: 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.

AB - Purpose: 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. Recommendations: 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.

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