Table 2.

Summary of guidelines on treatment of VTE in patients with cancer.

	NCCN 2011	ACCP 2012	ASCO 2013
Initial treatment	LMWH Dalteparin 200 U/kg OD Enoxaparin 1 mg/kg BID Tinzaparin 175 U/kg OD Fondaparinux 5 mg (<50 kg), 7.5 mg (50–100 kg), or 10 mg (>100 kg) OD APTT-adjusted UFH infusion	Not addressed in cancer patients	LMWH is recommended for the initial 5 to 10 days of treatment for DVT and PE in patients with a CrCI>30 mL/min.
Long-term treatment	- LMWH is recommended for first 6 months as monotherapy without warfarin in patients with proximal DVT or PE and metastatic or advanced cancer. - Warfarin 2.5–5 mg every day initially with dynamic dosing strategy based on INR value targeted at 2–3.	-LMWH preferred to VKA - In patients not treated with LMWH, VKA therapy is preferred to dabigatran or rivaroxaban - Patients receiving extended therapy should continue with the same agent used for the first 3 months of treatment	- LMWH is recommended for long-term therapy for DVT and PE - VKAs (target INR, 2–3) are acceptable for long-term therapy if LMWH is not available. - Use of novel oral anticoagulants is not recommended - Patients with cancer should be periodically assessed for VTE risk
Duration of therapy	Minimum 3 months. Indefinite anticoagulant if active cancer or persistent risk factors.	Extended therapy is preferred to 3 months of treatment	At least 6 months duration. Extended anticoagulation with LMWH or VKA beyond 6 months for patients with: - metastatic disease -receiving chemotherapy -recurrent thrombosis

Note: Adapted from Khorana AA2009,⁸ Lee ay 2013.⁴¹

Abbreviations: ACCP, American College of Chest Physicians; BID, twice-daily dosing; OD, once-daily dosing; NCCN, National Comprehensive Cancer Network; OD, once-daily dosing; ASCO, American Society of Clinical Oncology; EMSO, European Society of Medical Oncology; ACCP, American College of Chest Physicians; NCCP, National Cancer Comprehensive Network; DVT, Deep vein thrombosis; PE, Pulmonary embolism.