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Review
. 2022 Jul;23(7):e334-e347.
doi: 10.1016/S1470-2045(22)00160-7.

2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

Dominique Farge  1 , Corinne Frere  2 , Jean M Connors  3 , Alok A Khorana  4 , Ajay Kakkar  5 , Cihan Ay  6 , Andres Muñoz  7 , Benjamin Brenner  8 , Pedro H Prata  9 , Dialina Brilhante  10 , Darko Antic  11 , Patricia Casais  12 , María Cecilia Guillermo Esposito  13 , Takayuki Ikezoe  14 , Syed A Abutalib  15 , Luis A Meillon-García  16 , Henri Bounameaux  17 , Ingrid Pabinger  6 , James Douketis  18 ; International Initiative on Thrombosis and Cancer (ITAC) advisory panel
Collaborators, Affiliations
Review

2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

Dominique Farge et al. Lancet Oncol. 2022 Jul.

Abstract

The International Initiative on Thrombosis and Cancer is an independent academic working group of experts aimed at establishing global consensus for the treatment and prophylaxis of cancer-associated thrombosis. The 2013, 2016, and 2019 International Initiative on Thrombosis and Cancer clinical practice guidelines have been made available through a free, web-based mobile phone application. The 2022 clinical practice guidelines, which are based on a literature review up to Jan 1, 2022, include guidance for patients with cancer and with COVID-19. Key recommendations (grade 1A or 1B) include: (1) low-molecular-weight heparins (LMWHs) for the initial (first 10 days) treatment and maintenance treatment of cancer-associated thrombosis; (2) direct oral anticoagulants for the initial treatment and maintenance treatment of cancer-associated thrombosis in patients who are not at high risk of gastrointestinal or genitourinary bleeding, in the absence of strong drug-drug interactions or of gastrointestinal absorption impairment; (3) LMWHs or direct oral anticoagulants for a minimum of 6 months to treat cancer-associated thrombosis; (4) extended prophylaxis (4 weeks) with LMWHs to prevent postoperative venous thromboembolism after major abdominopelvic surgery in patients not at high risk of bleeding; and (5) primary prophylaxis of venous thromboembolism with LMWHs or direct oral anticoagulants (rivaroxaban or apixaban) in ambulatory patients with locally advanced or metastatic pancreatic cancer who are treated with anticancer therapy and have a low risk of bleeding.

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Conflict of interest statement

Declaration of interests DF is the founding cochair of the International Initiative on Thrombosis and Cancer. CF reports honoraria for lectures from Bayer, Bristol Myers Squibb, and LEO Pharma; and support for attending meetings from LEO Pharma and Pfizer, outside the submitted work. JMC reports research funding to her institution from CSL Behring; consulting fees from Abbott; honoraria for lectures from Bristol Myers Squibb, Roche, and Sanofi; and participated in the advisory board of Abbott, Alnylam, Anthos, Bristol Myers Squibb, Sanofi, and Takeda, outside the submitted work. AAK reports consulting fees from Anthos, Bayer, Bristol Myers Squibb, Janssen, Pfizer, and Sanofi; honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Anthos, Bayer, Bristol Myers Squibb, Janssen, Pfizer, and Sanofi; payment for expert testimony to his institution; and support for attending meetings or travel from Bayer, Janssen, Pfizer, and Sanofi, outside the submitted work. AK reports consulting fees from Verseon; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from CCL Pharma, outside the submitted work. CA reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Bayer, Bristol Myers Squibb, Daiichi-Sankyo, Pfizer, and Sanofi, outside the submitted work. AM reports royalties or licenses for risk assessment model in venous thromboembolism in patients with cancer; consulting fees from AstraZeneca, Bristol Myers Squibb, Celgene, Daiichi Sankyo, Incyte, Lilly, LEO Pharma, MSD, Pfizer, Roche, Sanofi, and Servier; honoraria for lectures from Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Daiichi Sankyo, Lilly, LEO Pharma, Menarini, Pfizer, Rovi, Sanofi, and Stada; and support for attending meetings or travel from Amgen, AstraZeneca, Celgene, Merck Serono, and Roche, outside the submitted work. BB reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Horiba Medical, Johnson & Johnson, Rovi, and Sanofi, outside the submitted work. DB reports honoraria for lectures from Bayer and Sanofi; support for attending meetings or travel from LEO Pharma and Sanofi; and participated in the advisory board of Apixabano (Pfizer), outside the submitted work. DA reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Roche, Janssen, Takeda, and Pfizer; participated in the advisory board of AstraZeneca, Bayer, Janssen, Pfizer, Roche, and Takeda, outside the submitted work; and is the president of the Serbian Lymphoma Group. PC reports support for attending meetings from Sanofi–Aventis, outside the submitted work, and is a member of the guidelines and guidance Committee of the International Society on Thrombosis and Haemostasis. MCGE reports support for attending meetings from Nolver Uruguay, outside the submitted work. TI reports honoraria for lectures from Asahi Kasei Pharma, Bristol Myers Squibb, Daiichi Sankyo, Nippon Shinyaku, and Pfizer, outside the submitted work. SAA reports grants or contract from AstraZeneca; support for attending meetings from Curoscience; and a leadership or fiduciary role in AstraZeneca, ASTCT, and ASSCO POS, outside the submitted work. LAM-G reports receiving consulting fees from Novartis; and honoraria for lectures from Novartis, Amgen, Astellas, AstraZeneca, Janssen, Roche, and Teva, outside the submitted work. HB participated in the data safety monitoring board of the COVID-HEP and the Dawn-Antico COVID-19 studies; is a member of the steering committee of the GARFIELD VTE Study; is the President of the Swiss Academy of Medical Science, the President of the Société Académique de Genève, and participated to the foundation board of the Promotion Santé Suisse outside the submitted work. IP reports honoraria for lectures and advisory boards from Bayer, Daiichi Sanchyo, Pfizer, and Sanofi, outside the submitted work; and is the Chair of the European Thrombosis and Haemostasis Association. JD reports consulting fees from Sanofi; honoraria for lectures from LEO Pharma, Pfizer, and Servier, outside the submitted work; and is the President of Thrombosis Canada and the cochair of the International Initiative on Thrombosis and Cancer. PHP declares no competing interests.

References

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Uncited Reference

    1. Deitcher SR, Kessler CM, Merli G, et al. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost. 2006;12:389–396. - PubMed

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