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Practice Guideline
. 2021 Feb 23;5(4):927-974.
doi: 10.1182/bloodadvances.2020003442.

American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer

Gary H Lyman  1   2 , Marc Carrier  3 , Cihan Ay  4 , Marcello Di Nisio  5 , Lisa K Hicks  6 , Alok A Khorana  7 , Andrew D Leavitt  8   9 , Agnes Y Y Lee  10   11 , Fergus Macbeth  12 , Rebecca L Morgan  13 , Simon Noble  14 , Elizabeth A Sexton  15 , David Stenehjem  16 , Wojtek Wiercioch  13 , Lara A Kahale  17 , Pablo Alonso-Coello  18
Affiliations
Practice Guideline

American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer

Gary H Lyman et al. Blood Adv. .

Erratum in

Abstract

Background: Venous thromboembolism (VTE) is a common complication among patients with cancer. Patients with cancer and VTE are at a markedly increased risk for morbidity and mortality.

Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the prevention and treatment of VTE in patients with cancer.

Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The guideline development process was supported by updated or new systematic evidence reviews. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess evidence and make recommendations.

Results: Recommendations address mechanical and pharmacological prophylaxis in hospitalized medical patients with cancer, those undergoing a surgical procedure, and ambulatory patients receiving cancer chemotherapy. The recommendations also address the use of anticoagulation for the initial, short-term, and long-term treatment of VTE in patients with cancer.

Conclusions: Strong recommendations include not using thromboprophylaxis in ambulatory patients receiving cancer chemotherapy at low risk of VTE and to use low-molecular-weight heparin (LMWH) for initial treatment of VTE in patients with cancer. Conditional recommendations include using thromboprophylaxis in hospitalized medical patients with cancer, LMWH or fondaparinux for surgical patients with cancer, LMWH or direct oral anticoagulants (DOAC) in ambulatory patients with cancer receiving systemic therapy at high risk of VTE and LMWH or DOAC for initial treatment of VTE, DOAC for the short-term treatment of VTE, and LMWH or DOAC for the long-term treatment of VTE in patients with cancer.

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Conflict of interest statement

Conflict-of-interest disclosure: All authors were members of the guideline panel, members of the systematic review team, or both. As such, they completed disclosure of interest forms, which were reviewed by ASH and are available as Supplement 2 and Supplement 3.

References

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