Originally published as JCO Early Release 10.1200/JCO.2007.14.1283 on October 29 2007

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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.

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