Venous Thromboembolism in Cancer Patients Undergoing Major Abdominal Surgery: Prevention and Management

Table 7

Comparison of VTE treatment recommendations laid down by ASCO, NCCN, and ESMO for patients with cancer.

	Initial treatment of established VTE						Long-term treatment
	Unfractionated heparin	Enoxaparin^#	Dalteparin^#	Fondaparinux^#	Tinzaparin	Duration	Dalteparin	Warfarin	Duration
NCCN [205] & ASCO [127]	80 U/kg IV bolus, then 18 U/kg/h IV(adjust level based on PTT^†)	1 mg/kg sc every 12 hours1.5 mg/kg sc daily	100 U/kg sc every 12 hours200 U/kg sc daily	<50 kg, 2.5 mg sc daily 50–100 kg, 5 mg sc daily100 kg, 7.5 mg sc daily	175 U/kg sc daily	For at least 5–7 days or until INR is in the therapeutic range for 2 consecutive days if changing to warfarin.	200 U/kg sc daily for 1 month; then 150 U/kg sc daily	5–10 mg PO daily; adjust dose to INR 2-3 when LMWH unavailable	Anticoagulation for an indefinite period should be considered for patients with active cancer (metastatic disease; continuing chemotherapy).
ESMO [128]	5000 IU bolus, then 30 000 IU continuous infusion over 24 h (adjust level based on PTT^†)	100 U/kg sc twice daily	200 U/kg sc once daily	NR	NR	For at least 5–7 days	150 U/kg sc daily	NR	6 months; Continued anticoagulation based on characteristics of malignancy

VTE: venous thromboembolism, ASCO: American Society for Oncology, NCCN: National Comprehensive Cancer Network, ESMO: European Society of Medical Oncology, IV: intravenously, sc: subcutaneously, po: orally, PTT: partial thromboplastin time, INR: international normalized ratio, NR: not recommended. ^#Significant renal clearance; avoid in patients with creatinine clearance 35 mL/min or adjust dose based on antifactor Xa levels.^†PTT: Partial Thromboplastin time range of 1.5 to 2.5 the control value is commonly used. The best approach is to determine the PTT therapeutic range using the local method, to correspond to a heparin level of 0.3 to 0.7 U/mL using a chromogenic Xa assay.