International Guidelines for Treatment and Prophylaxis of VTE in Patients With Cancer

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The 2019 International Initiative on Thrombosis and Cancer (ITAC) has issued updated clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism (VTE) in patients with cancer. They were published by Farge et al in The Lancet Oncology.

The guidelines consist of recommendations in the following areas.

Treatment of established VTE, including:

  • Initial treatment, with recommendations regarding use of low–molecular-weight heparin, unfractionated heparin, and fondaparinux
  • Early maintenance (up to 6 months) and long-term maintenance (beyond 6 months)
  • Treatment of VTE recurrence in patients with cancer under anticoagulation
  • Treatment of established catheter-related thrombosis.

Prophylaxis for patients with VTE, including:

  • Prophylaxis in patients with cancer who have undergone surgery
  • Prophylaxis in medically treated patients with cancer who are hospitalized
  • Prophylaxis in ambulatory patients with cancer who are receiving systemic anticancer therapy
  • Anticoagulant thromboprophylaxis in selected patients according to tumor type
  • Prophylaxis of central venous catheter-related VTE.

Risk stratification schemes for prophylaxis of VTE in patients with cancer, including information on risk factors, emerging biomarkers, and risk assessment models.

VTE treatment and prophylaxis in special cancer situations, including patients with brain tumors, thrombocytopenia, renal failure, or who are pregnant.

The authors concluded the guidelines with, “Cancer-associated thrombosis is a concerning problem for patients with cancer, increasing both morbidity and mortality. Direct oral anticoagulants have changed the approach to care for patients with atrial fibrillation and VTE, and new data now show a role for direct oral anticoagulants in cancer-associated thrombosis treatment and prophylaxis. The 2019 updated ITAC guidelines place these data in the framework of established approaches to all aspects of treatment and prophylaxis of cancer-associated thrombosis. The guidelines accompany a free ITAC continuing medical education web-based mobile app that will assist practicing clinicians with decision-making at a variety of levels to provide optimal care for patients with cancer to prevent and to treat VTE.”

ITAC guidelines are an academic initiative by the international branch of the Group Francophone Thrombose et Cancer. The guidelines have been endorsed by the International Society on Thrombosis and Haemostasis.

Dominique Farge, MD, of the Assistance Publique-Hopitaux de Paris, Saint-Louis Hospital, Universite de Paris, is the corresponding author of The Lancet Oncology article.

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