Designed and created by Guideline Central in participation with the American Society of Hematology
Management of Venous Thromboembolism: Prevention and Treatment in Patients with Cancer
Patient Guideline Summary
Publication Date: February 11, 2021
Last Updated: March 3, 2023
Objective
Objective
This patient summary means to discuss key recommendations from the American Society of Hematology (ASH) for the management of venous thromboembolism in cancer. It is limited to adults 18 years of age and older and should not be used as a reference for children.
Overview
Overview
- Venous thromboembolism (VTE) describes blood clots forming in veins and traveling, usually into the lungs.
- We will use the abbreviation DVT throughout this summary to refer to deep venous thrombosis and PE to refer to pulmonary embolism.
- There are two conditions in view here.
- DVT: blood clots in veins, most commonly in a leg. Severe cases threaten blood circulation in the affected limb.
- Embolism: the movement of a clot, usually into a lung. Large or multiple emboli can be life-threatening.
- Cancer greatly increases the risk of VTE and PE.
- Symptoms of DVT include pain, swelling, warmth, and discoloration of the affected limb.
- Symptoms of PE include difficulty breathing, chest discomfort, heart pounding, faintness, and coughing up blood.
- This patient summary focuses on the management of venous thromboembolism in patients with cancer.
Treatment
Treatment
All treatment decisions are based on the individual circumstances of each patient.
- Uncomplicated DVT and PE can be managed at home. More severe cases or otherwise unhealthy patients may require hospitalization.
- Medical treatment entails preventing the extension of the clot or dissolving the clot, or both.
- Thrombolysis (clot-dissolving) can be accomplished by giving certain drugs intravenously or through a catheter directly into a clot.
- Anticoagulation prevents further clotting by “thinning” the blood. There are several classes of anticoagulants.
- Injectable unfractionated heparin (UFH), low-molecular-weight heparin (LMWH)
- Fondaparinux injection
- Oral agents:
- Vitamin K antagonists (blockers)
- Aspirin
- Rivaroxaban, apixaban, edoxaban and dabigatran
- Mechanical treatments: These devices help pump blood out of the legs.
- Intermittent ankle flexers
- Pulsatile foot pumps
- Intermittent pneumatic compression devices
- Graduated compression stockings
- Surgical treatments:
- Open removal of clots
- Catheter placement of a filter above the clot to prevent it from moving into the lungs
Follow-up
- Duration of medical treatment is an individual decision weighing the severity of the condition, the risk of continued medication, and the general health of each patient.
Abbreviations
- ASH: American Society Of Hematology
- DVT: Deep Venous Thrombosis
- IVC: Inferior Vena Cava
- LMWH: Low Molecular Weight Heparin
- PE: Pulmonary Embolism
- UFH: Unfractionated Heparin
- VTE: Venous Thromboembolism
Source Citation
Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA, Leavitt AD, Lee AYY, Macbeth F, Morgan RL, Noble S, Sexton EA, Stenehjem D, Wiercioch W, Kahale LA, Alonso-Coello P. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021 Feb 23;5(4):927-974. doi: 10.1182/bloodadvances.2020003442. Erratum in: Blood Adv. 2021 Apr 13;5(7):1953. PMID: 33570602; PMCID: PMC7903232.
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.