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asco guidelines vte








[in German]Preventing venous thromboembolism in ambulatory cancer patients: The ONKOTEV studyA predictive score for thrombosis associated with breast, colorectal, lung, or ovarian cancer: The Prospective COMPASS-Cancer-Associated Thrombosis StudyMultivariable clinical-genetic risk model for predicting venous thromboembolic events in patients with cancerComparison of risk prediction scores for venous thromboembolism in cancer patients: A prospective cohort studyRisk assessment for cancer-associated thrombosis: What is the best approach?Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United StatesVenous thromboembolism in patients with acute leukemia, lymphoma, and multiple myelomaSimplicity versus complexity: An existential dilemma as risk tools evolveDevelopment and validation of a predictive model for chemotherapy-associated thrombosisDeep vein thrombosis (DVT) and pulmonary embolism (PE): Awareness and prophylaxis practices reported by patients with cancerCancer patients and awareness of venous thromboembolismPatient-clinician communication: American Society of Clinical Oncology consensus guidelineReview of venous thromboembolism and race: The generalizability of treatment guidelines for high-risk populationsVenous thromboembolism in patients with colorectal cancer: Incidence and effect on survivalVenous thromboembolism (VTE) in patients with advanced gastric cancer: An Asian experienceProspective study on the incidence of postoperative venous thromboembolism in Korean patients with colorectal cancerThe association between race and venous thromboembolism risk after initiation of chemotherapy: An analysis of the SAVE-ONCO trial control armUpdating the American Society of Clinical Oncology Value Framework: Revisions and reflections in response to comments receivedAmerican Society of Clinical Oncology Statement: A conceptual framework to assess the value of cancer treatment optionsCost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemiaPatient and plan characteristics affecting abandonment of oral oncolytic prescriptionsAmerican Society of Clinical Oncology guidance statement: The cost of cancer careIntegration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline updateTreatment of venous thromboembolism in patients with cancer: Subgroup analysis of the Matisse clinical trials




VKAs are inferior but may be used if LMWH or direct oral anticoagulants (DOACs) are not accessible.





However, it is the consensus of the Expert Panel, based on extrapolation from patients with unprovoked VTE, that continuing anticoagulation beyond 6 months should be considered for selected patients because of the persistent high risk of recurrence in those with active cancer.



For more information about ASCO's conflict of interest policy, please refer to No other potential conflicts of interest were reported.The Expert Panel thanks William Tew, MD, Tracey Weisberg, MD, Marc Carrier, MD, Jeffrey Zwicker, MD, and the Clinical Practice Guidelines Committee for their thoughtful reviews and insightful comments on this guideline. Additionally, the guideline asserts that filter insertion has no role for primary prevention or prophylaxis of PE or DVT, though a vena cava filter may be offered as an adjunct to anticoagulation in patients with progression of thrombosis. Patients with advanced pancreatic cancer have particularly high rates of VTE,Similar to the pancreas studies, six RCTs of LMWH thromboprophylaxis have been reported in patients with lung cancer, with overall rates of VTE of 7.9% and 4.0% in control and LMWH patients, respectively (RR, 0.51; 96% CI, 0.40 to 0.65) and a nonsignificant increase in major bleeding.Greater absolute reductions in the risk of VTE were also observed in selected, high-risk patients based on the Khorana risk score.In a newer phase of studies, clinical trials of risk-adapted thromboprophylaxis with DOACs in ambulatory patients with a Khorana score of 2 or higher starting new systemic antineoplastic therapy have been recently published.While neither AVERT nor CASSINI were adequately powered for safety end points, a small but consistent absolute increase in major bleeding of approximately 1% in the prophylactic DOAC arm of both studies was observed during the intervention period.



Consequently, VTE is an “important cause of morbidity and mortality” among cancer patients.According to the review, two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in cancer patients confirmed the efficacy of edoxaban and rivaroxaban, but found that they could be associated with an increased risk of bleeding compared to low-molecular-weight heparin (LMWH).

To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer.PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018.



Falanga is in accordance, adding, “The updated ASCO guidelines reflect the new evidence from clinical research showing the efficacy of new anticoagulant drugs for VTE management in oncology.


To provide information on outcomes after recurrent VTE, an international registry collected information about 212 patients with cancer and recurrent VTE despite anticoagulant therapy.Incidental findings of PE and/or DVT during routine staging with computed tomography scans of the abdomen and pelvis are frequently reported, as are splanchnic or visceral vein thrombi.



ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose.



Patients with cancer should be assessed for VTE risk initially and periodically thereafter, particularly when starting systemic antineoplastic therapy or at the time of hospitalization.






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asco guidelines vte