Medline ® Abstract for Reference 56
of 'Supportive care of the patient with locally advanced or metastatic exocrine pancreatic cancer'
Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014.
Lyman GH, Bohlke K, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, Clarke JM, Flowers CR, Francis CW, Gates LE, Kakkar AK, Key NS, Levine MN, Liebman HA, Tempero MA, Wong SL, Somerfield MR, Falanga A, American Society of Clinical Oncology
J Clin Oncol. 2015;33(6):654. Epub 2015 Jan 20.
PURPOSE: To provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer.
METHODS: PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from November 2012 through July 2014. An update committee reviewed the identified abstracts.
RESULTS: Of the 53 publications identified and reviewed, none prompted a change in the 2013 recommendations.
RECOMMENDATIONS: Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization. Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low-molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis (at least 6 months). Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer. Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should educate patients about the signs and symptoms of VTE.
Gary H. Lyman, Fred Hutchinson Cancer Research Center; Gary H. Lyman and Nicole M. Kuderer, University of Washington, Seattle, WA; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Agnes Y. Lee, University of British Columbia, Vancouver, British Columbia; Mark N. Levine, McMaster University, Hamilton, Ontario, Canada; Juan Ignacio Arcelus, Hospital Universitario Virgen de las Nieves, University of Granada, Granada, Spain; Edward P. Balaban, Cancer Care Partnership, Mount Nittany Health and Penn State Hershey Cancer Institute, State College, PA; Jeffrey M. Clarke, Duke University Medical Center, Durham; Nigel S. Key, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Charles W. Francis, James P. Wilmot Cancer Center and University of Rochester, Rochester, NY; Leigh E. Gates, Patient Repres