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Cancer-Associated Thrombosis
Declaration of sponsorship Pfizer and Bristol Myers Squibb

Cancer-Associated VTE Guidelines

Declaration of sponsorship Pfizer and Bristol Myers Squibb
Read time: 20 mins
Last updated:11th Nov 2020
Published:1st Nov 2020
Guidelines for cancer-associated venous thromboembolism (VTE) have largely recommended the use of low molecular weight heparin (LMWH) but recent updates now include the use of direct oral anticoagulant (DOAC) treatments.

Traditionally, anticoagulants used to treat signs and symptoms of VTE have included LMWH or vitamin K antagonists (VKAs). 

More recently, DOACs, have emerged as a potential option for pharmacologic thromboprophylaxis and for treatment of patients with cancer at risk or at high risk of VTE1

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LMWH has remained the standard treatment for cancer-associated VTE. 

However, with the increased use of DOACs, three recent randomised controlled trials have been conducted to compare the safety and efficacy of DOACs with LMWH3.

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Most hospitalised patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalisation. 

Thromboprophylaxis is not routinely recommended for all outpatients with cancer12.

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1, Patel, T. & Iglesias, D. A. Venous Thromboembolism Treatment and Prevention in Cancer Patients: Can We Use Pills Yet? Current Treatment Options in Oncology 2020;21:43

2. Ramacciotti, E. et al. Direct Oral Anticoagulants and Cancer-Associated Thrombosis Management. Where Do We Stand in 2019? Clinical and Applied Thrombosis/Hemostasis 2019;25

3. Treatment of Malignancy Associated Venous Thromboembolism - American College of Cardiology. Available at: (accessed 18 September 2020)

4. Lee, A. Y. Y. et al. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: A randomized clinical trial. JAMA - J. Am. Med. Assoc. 2015;314:677–686

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