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Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update.

Publication ,  Journal Article
Lyman, GH; Khorana, AA; Kuderer, NM; Lee, AY; Arcelus, JI; Balaban, EP; Clarke, JM; Flowers, CR; Francis, CW; Gates, LE; Kakkar, AK; Key, NS ...
Published in: J Clin Oncol
June 10, 2013

PURPOSE: To provide recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. Prophylaxis in the outpatient, inpatient, and perioperative settings was considered, as were treatment and use of anticoagulation as a cancer-directed therapy. METHODS: A systematic review of the literature published from December 2007 to December 2012 was completed in MEDLINE and the Cochrane Collaboration Library. An Update Committee reviewed evidence to determine which recommendations required revision. RESULTS: Forty-two publications met eligibility criteria, including 16 systematic reviews and 24 randomized controlled trials. RECOMMENDATIONS: Most hospitalized patients with cancer require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for outpatients with cancer. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low-molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major cancer surgery should receive prophylaxis, starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term (6 months) secondary prophylaxis. Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE. Anticoagulation should not be used for cancer treatment in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should provide patient education about the signs and symptoms of VTE.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

June 10, 2013

Volume

31

Issue

17

Start / End Page

2189 / 2204

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • United States
  • Risk Assessment
  • Practice Guidelines as Topic
  • Oncology & Carcinogenesis
  • Neoplasms
  • Humans
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

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Lyman, G. H., Khorana, A. A., Kuderer, N. M., Lee, A. Y., Arcelus, J. I., Balaban, E. P., … American Society of Clinical Oncology Clinical Practice, . (2013). Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 31(17), 2189–2204. https://doi.org/10.1200/JCO.2013.49.1118
Lyman, Gary H., Alok A. Khorana, Nicole M. Kuderer, Agnes Y. Lee, Juan Ignacio Arcelus, Edward P. Balaban, Jeffrey M. Clarke, et al. “Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update.J Clin Oncol 31, no. 17 (June 10, 2013): 2189–2204. https://doi.org/10.1200/JCO.2013.49.1118.
Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013 Jun 10;31(17):2189–204.
Lyman, Gary H., et al. “Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update.J Clin Oncol, vol. 31, no. 17, June 2013, pp. 2189–204. Pubmed, doi:10.1200/JCO.2013.49.1118.
Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, Clarke JM, Flowers CR, Francis CW, Gates LE, Kakkar AK, Key NS, Levine MN, Liebman HA, Tempero MA, Wong SL, Prestrud AA, Falanga A, American Society of Clinical Oncology Clinical Practice. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013 Jun 10;31(17):2189–2204.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

June 10, 2013

Volume

31

Issue

17

Start / End Page

2189 / 2204

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • United States
  • Risk Assessment
  • Practice Guidelines as Topic
  • Oncology & Carcinogenesis
  • Neoplasms
  • Humans
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences