ASCO GUIDELINES FOR VTE PROPHYLAXIS

As reported in the Journal of Clinical Oncology by Lyman et al, an ASCO update committee recommended no changes to the 2013 clinical practice guideline for venous thromboembolism (VTE) prophylaxis and treatment after review of 53 new publications in the area that became available between November 2012 and July 2014. The update committee was cochaired by Gary H. Lyman, MD, MPH, of Fred Hutchinson Cancer Research Center and University of Washington, Seattle, and Anna Falanga, MD, of Hospital Papa Giovanni XXIII, Bergamo, Italy.

The primary recommendations remain the following:

• Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization. Data are inadequate to support routine thromboprophylaxis in patients admitted for minor procedures or short chemotherapy infusion.
• Routine thromboprophylaxis is not recommended for ambulatory patients. It may be considered for highly select high-risk patients.
• Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy or dexamethasone should receive prophylaxis with either low–molecular-weight heparin or low-dose aspirin to prevent VTE.
• Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days.
• Extending postoperative prophylaxis up to 4 weeks should be considered in patients undergoing major abdominal or pelvic surgery with high-risk features.
• Low–molecular-weight heparin is recommended for the initial 5 to 10 days of treatment of established deep-vein thrombosis and pulmonary embolism, as well as for long-term secondary prophylaxis for at least 6 months.
• Use of novel oral anticoagulants is not currently recommended for patients with VTE.
• Anticoagulation should not be used to extend survival of patients in the absence of other indications.
• Patients should be periodically assessed for VTE risk.
• Oncology professionals should educate patients about the signs and symptoms of VTE.

For full disclosures of the study authors, visit jco.ascopubs.org.