Table 2.

Key recommendations of the latest guidelines for treatment and prevention of cancer-associated venous thromboembolism

Recommendations for treatment of CAT
European Society of Cardiology (ESC) 2022 (64)	Edoxaban, apixaban, or rivaroxaban are recommended for treatment of symptomatic or incidental VTE in patients without contraindications (class I, level A)
International Initiative on Thrombosis and Cancer (ITAC) 2022 (65)	Edoxaban, apixaban, or rivaroxaban are recommended for the treatment of VTE in patients with creatinine clearance ≥ 30 mL/min and in the absence of high risk of gastrointestinal or genitourinary bleeding, strong drug–drug interactions, or gastrointestinal absorption impairment (grade 1A) Treatment of established VTE should last ≥ 6 months (grade 1A); thereafter, termination or continuation of anticoagulation should be based on individual evaluation of the benefit-risk ratio, tolerability, drug availability, patient preference, and cancer activity (guidance in the absence of data)
American Society of Hematology (ASH) 2021 (66)	For short-term treatment of VTE (3–6 months), edoxaban, apixaban, or rivaroxaban are suggested over LMWH (conditional recommendation, low certainty in the evidence of effects +  + / +  +  + +) and VKA (conditional recommendation, very low certainty in the evidence of effects + / +  +  + +) For long-term anticoagulation (6 months), DOAC or LMWH are suggested (conditional recommendation, very low certainty in the evidence of effects + / +  +  + +)
National Comprehensive Cancer Network (NCCN) 2020 (67)	DOAC are recommended for treatment of VTE (grade 1)
American Society of Clinical Oncology (ASCO) 2019 (68)	Edoxaban and rivaroxaban are treatment options for VTE (evidence quality: high; strength of recommendation: strong) Anticoagulation beyond the initial 6 months should be offered to selected patients, such as those with metastatic disease or those receiving chemotherapy (evidence quality: low; strength of recommendation: weak to moderate) For long-term anticoagulation, edoxaban, rivaroxaban, or LMWH are preferred over VKA (evidence quality: high; strength of recommendation: strong)
Recommendations for primary prophylaxis
ESC 2022 (64)	Prophylaxis with apixaban, rivaroxaban, or LMWH may be considered for ambulatory patients at high risk of thrombosis receiving systemic therapy, if there are no significant contraindications (class IIb, level B)
ITAC 2022 (65)	Prophylaxis with apixaban or rivaroxaban is indicated in ambulatory patients with locally advanced or metastatic pancreatic cancer treated with systemic anticancer therapy, who have a low risk of bleeding (grade 1 B) Prophylaxis with apixaban or rivaroxaban is recommended in ambulatory patients who are receiving systemic anticancer therapy and are at intermediate to-high-risk of VTE, identified by a validated risk assessment model (i.e., a Khorana score ≥ 2), and not actively bleeding or not at a high risk for bleeding (grade 1B)
ASH 2021 (66)	Prophylaxis with apixaban or rivaroxaban is suggested for ambulatory patients at high risk for thrombosis receiving systemic therapy (conditional recommendation, moderate certainty in the evidence of effects +  +  + / +  +  + +)
NCCN 2020 (67)	Consider apixaban or rivaroxaban for up to 6 months in high-risk patients (Khorana score ≥ 2) starting a new chemotherapy regimen (grade 2A)

DOAC direct oral anticoagulants; LMWH low-molecular-weight heparin; VKA vitamin K antagonists; VTE venous thromboembolism