Treatment and Secondary Prophylaxis of Venous Thrombosis in Patients with Malignant Disease (178)

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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments. 

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty. 

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient. 

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Editorial Information

Last reviewed: 22/07/2026

Next review date: 31/05/2029

Author(s): Lisa Rodgers.

Version: 6

Approved By: Medicines Utilisation Subcommittee of ADTC

Document Id: 178

References

Agnes Y.Y. Lee, Mark N Levine, Ross Baker et al. Low-Molecular-Weight  Heparin  versus  a  Coumarin  for  the  Prevention  of  Recurrent  Venous  Thromboembolism  in Patients with Cancer. N Engl J Med 2003; 349:146-153

Giancarlo Agnelli,   Cecilia Becattini, Guy Meyer, Andres Muñoz et al., for the Caravaggio Investigators. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. N Engl J Med 2020; 382:1599-1607

Key, A. Khorana, M. Kuderer, K. Bohlke et al Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. DOI: 10.1200/JCO.19.01461 Journal of Clinical Oncology 38, no. 5 (February 10, 2020) 496-520.

Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer. 2007;110(10):2339-46.

Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, et al. Low- molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. The New England journal of medicine.

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Li  A, Garcia DA, Lyman GH, et al: Direct oral anticoagulant  (DOAC) versus  low-molecular-weight heparin  (LMWH) for treatment  of cancer  associated thrombosis (CAT):  A systematic review and meta-analysis.  Thromb Res 173:158-163, 2019

Robert D. McBane, Waldemar E. Wysokinski, Jennifer G. Le‑Rademacher et al. Apixaban and Dalteparin in Active Malignancy-Associated Venous Thromboembolism: The ADAM VTE Trial. J Thromb Haemost 2020; 18:411–421

Mulder FI, van Es N, Kraaijpoel N, Di Nisio M, Carrier M, Garcia D, et al. Efficacy and safety of edoxaban in clinically relevant subgroups: results from the Hokusai VTE Cancer randomized trial. Thrombosis research. 2018;164:S194.

Mandala , A. Falanga & F. Roila On behalf of the ESMO Guidelines Working Group. Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines Annals of Oncology 22 (Supplement 6): vi85– vi92, 2011

Nigel S. KeyAlok A. Khorana, Nicole M. Kuderer, et  al Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. Journal of Clinical Oncology 38, no. 5 (February 10, 2020) 496-520.

Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. The New England journal of medicine. 2018;378(7):615-24.

Steven R. Deitcher, Craig M. Kessler, Geno Merli et al. Secondary Prevention of Venous Thromboembolic Events in Patients with Active Cancer: Enoxaparin Alone Versus Initial Enoxaparin Followed by Warfarin for a 180-Day Period. Clin Appl Thromb Hemost 2006; 12:389–396

Trujillo-Santos, P. Prandoni, K. Rivron-Guillot et al. Clinical Outcome in Patients with Venous Thromboembolism and Hidden Cancer: Findings from the RIETE Registry. J Thromb Haemost 2008; 6:251–255

Venous thromboembolic diseases: diagnosis, management and thrombophilia testing

NICE guideline [NG158] Published: 26 March 2020.https://www.nice.org.uk/guidance/ng158 (accessed 1st May 2021)

Young AM, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, et al. Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D). Journal of clinical oncology : 2018;36(20):2017-23.