Originally published as JCO Early Release 10.1200/JCO.2007.14.1283 on October 29 2007
Journal of Clinical Oncology, Vol 25, No 34 (December 1), 2007: pp. 5490-5505
© 2007 American Society of Clinical Oncology.
American Society of Clinical Oncology Guideline: Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer
Gary H. Lyman,
Alok A. Khorana,
Anna Falanga,
Daniel Clarke-Pearson,
Christopher Flowers,
Mohammad Jahanzeb,
Ajay Kakkar,
Nicole M. Kuderer,
Mark N. Levine,
Howard Liebman,
David Mendelson,
Gary Raskob,
Mark R. Somerfield,
Paul Thodiyil,
David Trent,
Charles W. Francis
From the Duke University Medical Center, University of Rochester Medical Center, Rochester; Ospedali Riuiniti Bergamo, Italy; University of North Carolina, NC; Winship Cancer Institute; University of Tennessee; Barts and The London School of Medicine; Thrombosis Research Institute; Duke University Medical Center, NC; McMaster University; University of Southern California; Premiere Oncology; University of Oklahoma Health Sciences Center; American Society of Clinical Oncology, Alexandria, VA; New York Methodist Hospital; and Veterans Administration Cancer Center
Address reprint requests to the American Society of Clinical Oncology, 1900 Duke St, Suite 200, Alexandria, VA 22314; e-mail: guidelines{at}asco.org
Purpose To develop guideline recommendations for the use of anticoagulation in the prevention and treatment of venous thromboembolism (VTE) in patients with cancer.
Methods A comprehensive systematic review of the medical literature on the prevention and treatment of VTE in cancer patients was conducted and reviewed by a panel of content and methodology experts. Following discussion of the results, the panel drafted recommendations for the use of anticoagulation in patients with malignant disease.
Results The results of randomized controlled trials of primary and secondary VTE medical prophylaxis, surgical prophylaxis, VTE treatment, and the impact of anticoagulation on survival of patients with cancer were reviewed. Recommendations were developed on the prevention of VTE in hospitalized, ambulatory, and surgical cancer patients as well as patients with established VTE, and for use of anticoagulants in cancer patients without VTE to improve survival.
Conclusion Recommendations of the American Society of Clinical Oncology VTE Guideline Panel include (1) all hospitalized cancer patients should be considered for VTE prophylaxis with anticoagulants in the absence of bleeding or other contraindications; (2) routine prophylaxis of ambulatory cancer patients with anticoagulation is not recommended, with the exception of patients receiving thalidomide or lenalidomide; (3) patients undergoing major surgery for malignant disease should be considered for pharmacologic thromboprophylaxis; (4) low molecular weight heparin represents the preferred agent for both the initial and continuing treatment of cancer patients with established VTE; and (5) the impact of anticoagulants on cancer patient survival requires additional study and cannot be recommended at present.
published online ahead of print at www.jco.org on October 29, 2007.
Supported in part by grant No. 1K23 CA120587-01A1 from the National Cancer Institute (A.A.K.).
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Facebook  Reddit  Technorati  Twitter What's this?
Related Correspondence
- Treatment of Venous Thrombosis in Patients With Intracranial Malignancies
Carl D. Atkins
JCO 2008 26: 1905
[Full Text]
- Low Platelet Counts in Cancer Patients: Should Heparin for Venous Thromboembolism Prophylaxis Be Instituted?
Nishith K. Singh and Gaurav Sangwan
JCO 2008 26: 1906
[Full Text]
This article has been cited by other articles:
|
|
|
|
 
A. A. Khorana
Cancer and thrombosis: implications of published guidelines for clinical practice
Ann. Onc.,
June 26, 2009;
(2009)
mdp068v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Mandala, A. Falanga, F. Roila, and On behalf of the ESMO Guidelines Working Group
Management of venous thromboembolism in cancer patients: ESMO Clinical Recommendations
Ann. Onc.,
May 1, 2009;
20(suppl_4):
iv182 - iv184.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Verma and R. Garg
Report on a patient with pre-existing venous thrombosis and incidental malignancy undergoing urgent laparotomy: preoperative concerns
BMJ Case Reports,
March 5, 2009;
2009(mar05_1):
bcr1020081029 - bcr1020081029.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
D. MICKELSON, E. N. MADY, and K. TENG
A 43-year-old woman with chest pressure
Cleveland Clinic Journal of Medicine,
March 1, 2009;
76(3):
191 - 198.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Sousou and A. A. Khorana
New Insights Into Cancer-Associated Thrombosis
Arterioscler. Thromb. Vasc. Biol.,
March 1, 2009;
29(3):
316 - 320.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Rana, J. Julian, and M. Levine
P-selectin ready for prime time?
Blood,
February 19, 2009;
113(8):
1860 - 1860.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. A. Khorana and G. H. Lyman
Incidence and Prevention of Cancer-associated Thrombosis
ASCO Educational Book,
January 1, 2009;
2009(1):
321 - 325.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Y.Y. Lee
Treatment of Venous Thromboembolism in Patients with Cancer
ASCO Educational Book,
January 1, 2009;
2009(1):
331 - 336.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Nalluri, D. Chu, R. Keresztes, X. Zhu, and S. Wu
Risk of Venous Thromboembolism With the Angiogenesis Inhibitor Bevacizumab in Cancer Patients: A Meta-analysis
JAMA,
November 19, 2008;
300(19):
2277 - 2285.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Carrier, G. Le Gal, P. S. Wells, D. Fergusson, T. Ramsay, and M. A. Rodger
Systematic Review: The Trousseau Syndrome Revisited: Should We Screen Extensively for Cancer in Patients with Venous Thromboembolism?
Ann Intern Med,
September 2, 2008;
149(5):
323 - 333.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Prandoni, J. Trujillo-Santos, T. Surico, F. D. Valle, A. Piccioli, M. Monreal, and for the RIETE Investigators
Recurrent thromboembolism and major bleeding during oral anticoagulant therapy in patients with solid cancer: findings from the RIETE registry
Haematologica,
September 1, 2008;
93(9):
1432 - 1434.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. F. Collen, J. L. Jackson, A. F. Shorr, and L. K. Moores
Prevention of Venous Thromboembolism in Neurosurgery: A Metaanalysis
Chest,
August 1, 2008;
134(2):
237 - 249.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. E. Gerber, J. B. Segal, M. Y. Levy, J. Kane, R. J. Jones, and M. B. Streiff
The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention
Blood,
August 1, 2008;
112(3):
504 - 510.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Dicato
Venous Thromboembolic Events and Erythropoiesis-Stimulating Agents: An Update
Oncologist,
May 1, 2008;
13(suppl_3):
11 - 15.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. D. Atkins
Treatment of Venous Thrombosis in Patients With Intracranial Malignancies
J. Clin. Oncol.,
April 10, 2008;
26(11):
1905 - 1905.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. A. Khorana, C. W. Francis, A. Falanga, and G. H. Lyman
In Reply
J. Clin. Oncol.,
April 10, 2008;
26(11):
1906 - 1907.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. K. Singh and G. Sangwan
Low Platelet Counts in Cancer Patients: Should Heparin for Venous Thromboembolism Prophylaxis Be Instituted?
J. Clin. Oncol.,
April 10, 2008;
26(11):
1906 - 1906.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. N. Brown and J. D. Herrington
Review of the Relationship Between Venous Thromboembolism, Malignancy and Its Treatment
Journal of Pharmacy Practice,
April 1, 2008;
21(2):
126 - 137.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. A. Khorana, H. A. Liebman, R. H. White, T. Wun, and G. H. Lyman
The Risk of Venous Thromboembolism in Patients with Cancer
ASCO Educational Book,
January 1, 2008;
2008(1):
240 - 248.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. W. Francis, A. K. Kakkar, M. N. Levine, and G. H. Lyman
Prevention of Venous Thromboembolism in Patients with Cancer
ASCO Educational Book,
January 1, 2008;
2008(1):
250 - 256.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Falanga, A. Y. Y. Lee, M. B. Streiff, and G. H. Lyman
Anticoagulation in the Treatment of Venous Thromboembolism in Patients with Cancer
ASCO Educational Book,
January 1, 2008;
2008(1):
258 - 268.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
