ASH_hematology VTE Guidelines In Patients With Cancer
12 Mar, 2021
Dr. Rajesh Bollam
1/ New @ASH_hematology VTE guidelines in patients with cancer:
Summary below,
= Strong recommendation (only 2/34)
2/ Hospitalized medical patients with cancer WITHOUT VTE:
Ppx>no ppx
Pharmacologic>mechanical
Pharmacologic > mechanical+pharmacologic
LMWH>UFH
Stop thromboppx at discharge
3/ Patients with cancer WITHOUT VTE with surgery:
Low bleeding risk: pharm>mech
High bleeding risk: mech>pharm
High thrombosis + low bleeding risk: mech+pharm>either alone
LMWH or fondaparinux>UFH
No VKA or DOAC for ppx
Major abd/pelvic surgery: cont pharm post dc
4/ Ambulatory patients with cancer on systemic therapy:
Low thrombosis risk: no parenteral ppx
Int thrombosis risk: no parenteral ppx
Low thrombosis risk: no ppx>VKA or DOAC
Int thrombosis risk: DOAC>no ppx
High thrombosis risk: LMWH>no ppx, DOAC>no ppx
5/ Ambulatory patients with cancer on systemic therapy (cont):
No ppx>VKA
For patients with multiple myeloma on lenalidomide/thalidomide/pomalidomide, use low-dose ASA + fixed-dose VKA or LMWH
Patients with cancer and a CVC:
No oral ppx
6/ Initial rx in first week for patients with active cancer + VTE:
Use DOAC or LMWH
LMWH>UFH
LMWH>fondaparinux
7/ Short-term (3-6 months) rx for active cancer + VTE:
DOAC>LMWH or VKA
LMWH>VKA
Incidental or subsegmental PE or visceral/splanchnic vein thrombosis: short-term anticoagulation > observation
CVC-related VTE: keep CVC
Recurrent VTE on LMWH: 
LMWH dose, no IVC filter
8/ Long-term (>6 months) rx for active cancer + VTE:
>6 months anticoagulation > 3-6 months alone
Continue indefinite anticoagulation over stopping after a period
Use DOAC or LMWH
#DrRajeshBollam #HematoOncologist #CancerSpecialist #cancerdoctor #VTE #anticoagulation #hyderabad #Secundrabad #telangana
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