ASH_hematology VTE Guidelines In Patients With Cancer

12 Mar, 2021

Dr. Rajesh Bollam

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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

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