Table 1.
International guidelines for the long-term treatment of cancer-associated thrombosis.
| International Guidelines | Long-Term Anticoagulation | Treatment Duration |
|---|---|---|
| ACCP [5] | LMWH over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C), or edoxaban (Grade 2C) | >3 months in patients at low bleeding risk (1B) or high risk of bleeding (2B) |
| ASCO [6] | LMWH, edoxaban, or rivaroxaban for at least 6 months are preferred because of improved efficacy over vitamin K antagonists (VKA). Caution with DOAC warranted in settings with high risk for mucosal bleeding. Drug-drug interaction should be checked prior to using a DOAC (strong) |
Anticoagulation with LMWH, DOAC, or VKA beyond the initial 6 months should be offered to select patients with active cancer, such as those with metastatic disease or those receiving chemotherapy (weak to moderate). |
| ACI FORUM [9] | LMWH | At least 6 months Stop treatment in the absence of tumor activity of antineoplastic treatment On the contrary, maintain treatment beyond 6 months with periodic re-evaluation of benefit/risk ratio |
| ITAC-CME [4] | LMWH preferred to VKA (1A) DOAC if CrCl ≥ 30 mL/min, in the absence of drug-drug interactions or insufficient digestive absorption (1A) Precaution if GI cancer |
At least 6 months (1A) Beyond 6 months discuss prolongation case by case based on the analysis of benefit/risk ratio (Guidance) |
| NCCN [10] | LMWH recommended Category 1 recommendations for both edoxaban and apixaban VKA possible |
At least 3 months Maintain treatment as long cancer is active, anti-neoplastic treatment maintained or increased risk of VTE recurrence (2A) |
| IFS [7] | LMWH recommended (1+) DOAC if LMWH not tolerated (2+) |
At least 6 months Maintain treatment beyond 6 months as long cancer is active, based on patient’s preference, bleeding risk: LMWH (2+), VKA (2+) or DOAC (2+) full treatment dose |
ACCP: American College of Chest Physicians; ASCO: American Society of Clinical Oncology; ITAC-CME: International Initiative on Thrombosis and Cancer; NCCN: National Comprehensive Cancer Network; ISF: Inter French Societies; LMWH: low-molecular-weight heparin; VKA: vitamin K antagonist; DOAC: direct oral anticoagulant; VTE: venous thromboembolism.