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ASCO updates recommendations on venous thromboembolism prevention, treatment for patients with cancer
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Direct oral anticoagulants should be used to prevent venous thromboembolism among certain patients with cancer, as well as to treat those who develop blood clots, according to updated ASCO recommendations published in Journal of Clinical Oncology.
“These recommendations are the first update to the guidelines since 2015,” Nigel S. Key, MB, ChB, FRCP, director of the UNC Hemophilia and Thrombosis Center at The University of North Carolina at Chapel Hill, and a HemOnc Today Editorial Board Member, told HemOnc Today. “The most notable change is the addition of direct oral anticoagulants to the available options for [VTE] prevention and treatment.”
ASCO first published guidelines on prevention and treatment of VTE among patients with cancer in 2007. The society updated the guidelines in 2013 and 2015. In 2018, ASH released its first comprehensive guidelines on VTE prevention and treatment.
Key and colleagues reviewed 35 publications from PubMed and the Cochrane Library on VTE prophylaxis and treatment and 18 publications on VTE risk management.
Based on the review, researchers made changes to the recommendations that included provisions for clinicians to prescribe apixaban (Eliquis, Bristol-Myers Squibb), rivaroxaban (Xarelto, Janssen) or low-molecular-weight heparin to selected high-risk outpatients with cancer for the prevention of VTE, as well as to offer rivaroxaban and edoxaban (Savaysa, Daiichi-Sankyo) for VTE treatment. The changes also address VTE treatment for patients with brain metastases and expand recommended uses for long-term postoperative low-molecular-weight heparin.
The guideline update reaffirmed that:
- most hospitalized patients with cancer and an acute medical condition should receive preventive treatment for VTE throughout their hospitalization;
- patients undergoing major cancer surgery should begin prophylaxis before surgery and should continue for at least 7 to 10 days following surgery;
- thromboprophylaxis should not be used for all outpatients with cancer; and
- patients with cancer should be periodically assessed for VTE risk, with oncology professionals providing patient education about the signs and symptoms of VTE.
These recommendations should serve to assist clinicians in decision-making and not be interpreted as a statement of standard of care, the authors wrote.
“With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read,” Key told HemOnc Today. “The information is not continually updated and may not reflect the most recent evidence. [It] addresses only the topics specifically identified therein and is not applicable to other interventions, diseases or stages of diseases.” – by John DeRosier
For more information:
Nigel Key, MB, ChB, FRCP, can be reached at The University of North Carolina Hemophilia and Thrombosis Center, Campus Box #7016, Chapel Hill, NC 27599-7017; email: nigel_key@med.unc.edu.
Disclosures: Key reports consultant/advisory roles with Genentech, Roche, Seattle Genetics, Shire Human Genetic Therapies and Uniqure; honoraria from Novo Nordisk; and research funding from Baxter Biosciences, Grifols and Pfizer. Please see the study for all other authors’ relevant financial disclosures.
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