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Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update.
J Clin Oncol. 2020 02 10; 38(5):496-520.JC

Abstract

PURPOSE

To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer.

METHODS

PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommendations as needed.

RESULTS

The systematic review included 35 publications on VTE prophylaxis and treatment and 18 publications on VTE risk assessment. Two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in patients with cancer reported that edoxaban and rivaroxaban are effective but are linked with a higher risk of bleeding compared with low-molecular-weight heparin (LMWH) in patients with GI and potentially genitourinary cancers. Two additional RCTs reported on DOACs for thromboprophylaxis in ambulatory patients with cancer at increased risk of VTE.

RECOMMENDATIONS

Changes to previous recommendations: Clinicians may offer thromboprophylaxis with apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban and edoxaban have been added as options for VTE treatment; patients with brain metastases are now addressed in the VTE treatment section; and the recommendation regarding long-term postoperative LMWH has been expanded. Re-affirmed recommendations: Most hospitalized patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE.Additional information is available at www.asco.org/supportive-care-guidelines.

Authors+Show Affiliations

University of North Carolina, Chapel Hill, NC.Cleveland Clinic, Cleveland, OH.Advanced Cancer Research Group and University of Washington, Seattle, WA.American Society of Clinical Oncology, Alexandria, VA.BC Cancer Agency, Vancouver, British Columbia, Canada.University of Granada, Granada, Spain.Dartmouth-Hitchcock Medical Center, Lebanon, NH.Penn State Cancer Institute, Hershey, PA.Emory University, Atlanta, GA.James P Wilmot Cancer Center and University of Rochester, Rochester, NY.Patient Representative, Denver, CO.Thrombosis Research Institute and University College, London, United Kingdom.McMaster University, Hamilton, Ontario, Canada.University of Southern California and Norris Comprehensive Cancer Center, Los Angeles, CA.University of California, San Francisco, San Francisco, CA.Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA.Hospital Papa Giovanni XXIII, Bergamo; and University of Milan Bicocca, Milan, Italy.

Pub Type(s)

Journal Article
Practice Guideline
Systematic Review

Language

eng

PubMed ID

31381464

Citation

Key, Nigel S., et al. "Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 38, no. 5, 2020, pp. 496-520.
Key NS, Khorana AA, Kuderer NM, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020;38(5):496-520.
Key, N. S., Khorana, A. A., Kuderer, N. M., Bohlke, K., Lee, A. Y. Y., Arcelus, J. I., Wong, S. L., Balaban, E. P., Flowers, C. R., Francis, C. W., Gates, L. E., Kakkar, A. K., Levine, M. N., Liebman, H. A., Tempero, M. A., Lyman, G. H., & Falanga, A. (2020). Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 38(5), 496-520. https://doi.org/10.1200/JCO.19.01461
Key NS, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020 02 10;38(5):496-520. PubMed PMID: 31381464.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. AU - Key,Nigel S, AU - Khorana,Alok A, AU - Kuderer,Nicole M, AU - Bohlke,Kari, AU - Lee,Agnes Y Y, AU - Arcelus,Juan I, AU - Wong,Sandra L, AU - Balaban,Edward P, AU - Flowers,Christopher R, AU - Francis,Charles W, AU - Gates,Leigh E, AU - Kakkar,Ajay K, AU - Levine,Mark N, AU - Liebman,Howard A, AU - Tempero,Margaret A, AU - Lyman,Gary H, AU - Falanga,Anna, Y1 - 2019/08/05/ PY - 2019/8/6/pubmed PY - 2020/9/9/medline PY - 2019/8/6/entrez SP - 496 EP - 520 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 38 IS - 5 N2 - PURPOSE: To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. METHODS: PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommendations as needed. RESULTS: The systematic review included 35 publications on VTE prophylaxis and treatment and 18 publications on VTE risk assessment. Two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in patients with cancer reported that edoxaban and rivaroxaban are effective but are linked with a higher risk of bleeding compared with low-molecular-weight heparin (LMWH) in patients with GI and potentially genitourinary cancers. Two additional RCTs reported on DOACs for thromboprophylaxis in ambulatory patients with cancer at increased risk of VTE. RECOMMENDATIONS: Changes to previous recommendations: Clinicians may offer thromboprophylaxis with apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban and edoxaban have been added as options for VTE treatment; patients with brain metastases are now addressed in the VTE treatment section; and the recommendation regarding long-term postoperative LMWH has been expanded. Re-affirmed recommendations: Most hospitalized patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE.Additional information is available at www.asco.org/supportive-care-guidelines. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/31381464/Venous_Thromboembolism_Prophylaxis_and_Treatment_in_Patients_With_Cancer:_ASCO_Clinical_Practice_Guideline_Update_ L2 - https://ascopubs.org/doi/10.1200/JCO.19.01461?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -