|
| Guidelines and pharmacologic prophylaxis | VKA | UFH | LMWH | FXa-I |
|
| American College of Chest Physicians (ACCP) | |
No |
Yes (SQ) |
Yes |
Yes |
| (Prevention in cancer patients (medical and surgical)) | |
|
|
Duration of prevention: (1) For medical oncology cancer patients who have acute medical illness or who are bedridden for the duration of hospitalization. (2) For surgical cancer patients (pelvic, abdominal, orthopedic) duration of prophylaxis up to 4 weeks. (3) In the presence of contraindications or high risk of bleeding, mechanical methods may be temporarily substituted and pharmacologic prophylaxis should resume after risk of bleeding subsides. |
|
| American College of Chest Physician(ACCP) | Acute | No | No | Yes | Not addressed |
| (Treatment in cancer patients) | Long term | Yes | No | Yes | No |
|
|
Duration of treatment: At least 3 months of treatment with LMWH, followed by treatment with either LMWH or VKA. |
|
| American Society of Clinical Oncology (ASCO) | |
No |
Yes (SQ) |
Yes |
Yes |
| (Prevention in cancer patients) | |
|
|
Duration of prevention: (1) For as long as the patient is hospitalized (due to surgery or acute medical illness) or until the patient is ambulatory. (2) In the presence of contraindication or high risk of bleeding, mechanical methods may be temporarily substituted and pharmacologic prophylaxis should resume after risk of bleeding subsides. (3) In certain multiple myeloma patients receiving thrombogenic chemotherapy (lenalidomide or thalidomide with dexamethasone), low-dose VKA (INR~1.5) or enoxaparin (40 mg) may be considered. |
|
| American Society of Clinical Oncology (ASCO) | Acute 5–10 days | No | Yes (IV) | Yes | Yes |
| (Treatment in cancer patients) | Long term | Yes | No | Yes | Not addressed |
|
|
Duration of treatment: LMWH is preferred for 5–10 days, then LMWH for at least 6 months. VKA may be substituted if LMWH is not accessible. After 6 months of treatment, indefinite treatment duration for cancer patients with metastasis or those actively receiving chemotherapy. |
|
| National Comprehensive Cancer Network (NCCN) | |
Yes |
Yes (SQ) |
Yes |
Yes |
| (Prevention in cancer patients) | |
|
|
Duration of prevention: (1) For the duration of hospitalization for medical illness and up to 4 weeks in surgical cancer patients. (2) In the presence of contraindication, use mechanical prophylaxis until bleeding risk subsides. (3) In certain high-risk medical oncology patients (i.e., aggressive tumor such as pancreatic, gastric, lymphoma, or in cases of obesity or prior VTE), longer prophylaxis is recommended. (4) In certain multiple myeloma patients receiving thrombogenic chemotherapy (lenalidomide or thalidomide with dexamethasone), VKA (INR of 2-3) or aspirin (81–325 mg) may be considered. |
|
| National Comprehensive Cancer Network (NCCN) | Acute 5–10 days | No | Yes (IV) | Yes | Yes |
| (Treatment in cancer patients) | Long term | Yes | No | Yes | Not addressed |
|
|
Duration of treatment: (1) LMWH is preferred for the first 3–6 months in DVT and 6–12 months in PE. (2) VKA can be considered if LMWH is not accessible. |
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