News

Guidelines Updated for Prevention and Treatment of Blood Clots in Cancer Patients

The American Society of Clinical Oncology (ASCO) has updated the guidelines for prevention and treatment for venous thromboembolism (VTE) – blood clots – in cancer patients. These results were recently published in the Journal of Clinical Oncology.

Venous thromboembolism occurs more frequently in patients with cancer than those without cancer. Fortunately, if caught early, many VTE can be treated prior to complications; many can even be prevented with preventive therapy. However, VTE has the potential to cause complications that can be life-threatening.

ASCO recently updated its recommendations in both the prevention (prophylaxis) and treatment of VTE in patients with cancer. The updates were based on a review of 42 publications including 16 systematic reviews and 24 clinical trials that included review of VTE in the outpatient, inpatient and perioperative settings with cancer patients. Prophylaxis, treatment, and use of anticoagulation were evaluated in these studies.

In general terms, the guidelines state the following:

Most cancer patients who are hospitalized should be treated with prophylaxis against VTE throughout their hospitalization.
Patients who are receiving care on an outpatient basis do not generally require prophylactic treatment against VTE, except for those who are at a high-risk for developing VTE.
Patients undergoing major surgery for cancer should receive prophylaxis against VTE starting before surgery and lasting for at least 7-10 days; 4 weeks should be considered for those who are at a high risk of developing VTE.
Patients with multiple myeloma who are being treated with antiangiogenesis agents plus chemotherapy and/or dexamethasone should receive prophylaxis against VTE with either low-molecular weight (LMWH) or low-dose aspirin.
For treatment of VTE once it has already developed should include LMWH for the initial 5-10 days of deep vein thrombosis (DVT) or pulmonary embolism (PE) – two forms of VTE for 6 months.
Novel oral anticoagulants should not be used as treatment for VTE in cancer patients.
Complete updated guidelines can be found here: http://www.asco.org/sites/www.asco.org/files/vte_recs_and_dosing_4.18.13.pdf.

Patient information regarding VTE, including signs and symptoms to look for, can be found here: http://www.asco.org/sites/www.asco.org/files/vte_pt_ed_sheet_4.18.13.pdf

The recommendations also included the fact that oncology healthcare providers should discuss the signs and symptoms of VTE with their patients, as well as ways in which to reduce their risk of developing VTE.

Reference: Lyman G, Khorana A, Kuderer N, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer: American Society of Clinical Oncology Clinical Practice Guidelines Update. Journal of Clinical Oncology. 2013;31(17):2189-2204.