Consider UFH, LMWH, or fondaparinux (strongly consider if bedridden and active cancer)
Ambulatory patients free of VTE but receiving systemic chemotherapy
Routine prophylaxis not recommended (conflicting data, risk of haemorrhage, low risk of VTE)
Patients with myeloma free of VTE on thalidomide or lenalidomide plus chemotherapy or dexamethasone
LMWH or low dose warfarin (target INR 1.5)
About to undergo surgery
Consider UFH, LMWH, or fondaparinux for 7–10 days. Consider extended (4 week) prophylaxis with LMWH after major surgery, obesity, and a history of VTE.
Those with established VTE to prevent recurrence
LMWH 5–10 days in the initial phase, then long-term treatment (6 months) with LMWH preferred to oral anticoagulation.
Active cancer (metastatic disease, continuing chemotherapy).
Indefinite anticoagulation should be considered
Table amended from [148]. See also [149, 150]. UFH: unfractionated heparin. LMWH: low molecular weight heparin. VTE: venous thromboembolism.
