| Diagnosis | - •
Imaging remains necessary to confirm or refute a diagnosis of DVT or PE in most patients with cancer who present with suspected VTE. - •
Management studies have not been done to demonstrate that a normal D-dimer level safely excludes VTE in patients with cancer who present with suspected VTE.
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| Prophylaxis | - •
The Khorana score should be used to estimate the 6-mo risk of symptomatic VTE in patients starting chemotherapy. - •
Thromboprophylaxis with LMWH, apixaban or rivaroxaban are options to prevent VTE in ambulatory patients with cancer who have a higher risk of VTE (eg, those with Khorana score of 2 or higher). - •
Primary thromboprophylaxis beyond 6 mo has not been studied. - •
Routine anticoagulation prophylaxis for the prevention of catheter-related thrombosis is not recommended, although some patients may benefit (eg, those with Khorana score of ≥2).
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| Treatment | - •
Evidence and guidelines support the selected use of LMWH, apixaban, edoxaban, or rivaroxaban. - •
Guidelines recommend a minimum of 3-6 mo of anticoagulation for the treatment of cancer-associated VTE, after which the decision to continue or stop anticoagulation is guided by a clinical assessment of ongoing patient- and cancer-related risk factors for thrombosis (such as chemotherapy, progressive cancer, or metastatic disease) vus the risk of bleeding - •
Treat catheter-related thrombosis for a minimum of 3 mo and continue anticoagulation beyond 3 mo if the catheter remains in place.
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| Anticoagulant precautions | - •
Inform patients of the potential risks, review the signs and symptoms of VTE and bleeding before prescribing any anticoagulant. - •
Check for potential drug–drug interactions prior to prescribing a DOAC. - •
Avoid DOAC in patients who may develop severe thrombocytopenia (<50 × 109/L), have significant upper gastrointestinal surgery, severe liver, or renal impairment, and in those taking strong CYP3A4 or P-glycoprotein modulators.
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