Table 5.

Role of the Direct Oral Anticoagulants in the Prevention of Cancer-Associated Thrombosis in Ambulatory Patients in Recent Guidelines

Guideline	Recommendations Regarding DOACs
ISTH 2019,88	DOACs (apixaban, rivaroxaban) are suggested for ambulatory cancer patients starting chemotherapy, with Khorana score ≥2, without drug interactions and without high bleeding risk (eg, gastroesophageal tumours).
ASCO 2020,4	DOACs (apixaban, rivaroxaban) or LMWH may be offered to high-risk ambulatory cancer patients (Khorana score ≥2 prior to starting new chemotherapy), if low bleeding risk and no drug interactions.
ASH 2021,5	DOACs (apixaban, rivaroxaban) or no thromboprophylaxis is suggested for ambulatory cancer patients at intermediate VTE risk, receiving systemic cancer therapy. Caution in patients at high bleeding risk. DOACs (apixaban, rivaroxaban) or LMWH is suggested for ambulatory cancer patients at high VTE risk, receiving systemic cancer therapy. Caution in patients at high bleeding risk.
ITAC 2022,87	DOACs (apixaban, rivaroxaban) are recommended for primary thromboprophylaxis in ambulatory cancer patients at intermediate/high VTE risk (defined as Khorana score ≥ 2) receiving chemotherapy, if no active bleeding or high risk of bleeding. DOACs (apixaban, rivaroxaban) or LMWH are recommended for primary thromboprophylaxis in ambulatory cancer patients with locally advanced or metastatic pancreatic cancer, receiving chemotherapy and with low bleeding risk.

Abbreviations: ASCO, American Society of Clinical Oncology; ASH, American Society of Hematology; DOACs, direct oral anticoagulants; ISTH, International Society on Thrombosis and Haemostasis; ITAC, International Initiative on Thrombosis and Cancer; LMWH, low molecular weight heparin; VTE, venous thromboembolism.