Table 2.

Summary of guideline recommendations for CA-VTE treatment and thromboprophylaxis in patients with cancer

Guideline	Year	CA-VTE Treatment		Thromboprophylaxis
		Preferred or first-line option	Alternative or second-line options
ISTH [27]	2018	If low risk of bleeding and no drug–drug interactions: DOACs	LMWH	NA
ESC [10]	2019	LMWH	Edoxaban or rivaroxaban	NA
ASCO [20]	2019	Initial treatment: LMWH, UFH, fondaparinux, or rivaroxaban Up to six months: LMWH, edoxaban, or rivaroxaban Long term anticoagulation: LMWH, DOAC, or VKA	If unable to obtain LMWH, edoxaban, or rivaroxaban: VKA	High-risk ambulatory patients (Khorana score ≥ 2): LMWH, apixaban, or rivaroxaban
NCCN [28]	2020	Patients without gastric or gastrointestinal lesions: Apixaban, rivaroxaban, or edoxaban Patients with gastric or gastrointestinal lesions: Dalteparin or enoxaparin	Dabigatran (with LMWH or UFH for at least 5 days), fondaparinux, UFH, or warfarin	High risk ambulatory patients (Khorana score ≥ 2): Apixaban or rivaroxaban
ITAC [21]	2020	Initial treatment and for up to six months: • if CrCl ≥ 30 mL/min: LMWH • if CrCl ≥ 30 mL/min, patient has low risk of GI or genitourinary bleeding, and no drug–drug interactions: Edoxaban, or rivaroxaban	If no contraindications: Fondaparinux If patient has contraindication for LMWH or DOACs: UFH	If hospitalized with reduced mobility and CrCl ≥ 30 mL/min: LMWH or fondaparinux, or UFH For patients with pancreatic cancer or Khorana score ≥ 2 while receiving systemic anticancer therapy at intermediate-to-high risk of VTE and not actively, or at a high-risk of, bleeding: Rivaroxaban, apixaban, or LMWH Immunomodulatory drugs combined with steroids or other systemic anticancer therapies: VKA (at low or therapeutic dose), LMWH, or low-dose aspirin
ASH [19]	2021	Initial treatment: LMWH Up to six months: DOACs Long term anticoagulation: DOACs or LMWH	If patient has contraindication for LMWH or DOACs: UFH	If hospitalized: LMWH High risk ambulatory patients receiving systemic therapy: Rivaroxaban or apixaban
CHEST [22]	2021	DOACs	LMWH	NA

Abbreviations: CA-VTE cancer-associated VTE, DOACs direct oral anticoagulants, LMWH low-molecular-weight heparin, UFH unfractionated heparin, VKA Vitamin K Antagonist. ISTH International Society on Thrombosis and Haemostasis, ESC European Society of Cardiology, ASCO American Society of Clinical Oncology, NCCN National Comprehensive Cancer Network, ITAC International Initiative on Thrombosis and Cancer, CHEST American College of Chest Physicians, NA no specific recommendation for DOACs is available