Download Guidelines for Treatment of Cancer

Guidelines for Treatment of Cancer-Associated Thrombosis
Last updated Jan 2012
Acute* VTE confirmed
AND
active malignancy
Long-term LMWH
covered by
insurance?
Case management
consult to assess
insurance coverage
of long-term LMWH
YES
NO
LMWH ONLY for 1st 3-6
months of therapy then
possible transition to warfarin
therapy
Induction therapy with LMWH
or fondaparinux for minimum
of 5 days along with warfarin
until INR >2 and stable
(DO NOT USE FONDAPARINUX)
Indefinite duration of therapy
or until resolution of cancer, as
per CHEST guidelines
*Acute VTE – diagnosed on/during this admission

LMWH=enoxaparin
For specific dosing of these agents, see oral or parenteral anticoagulant dosing guidelines on the
UNMH Pharmacy webpage
https://hospitals.health.unm.edu/intranet/pharmacy/drug_info.shtml
REFERENCES:
ACCP Guidelines: Kearon C et al et al. Antithrombotic therapy for venous thromboembolic disease. American
College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (suppl
6):454-545.
Hull R, et al. A randomised trial evaluating long-term low-molecular-weight heparin therapy for three months vs.
intravenous heparin followed by warfarin sodium in patients with current cancer [abstract]. Thromb Haemost
2003;(suppl),P137a
Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of
recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003;349,146-153.
Lee AY et al. Randomized comparison of low molecular weight heparin and coumarin derivatives on the survival of
patients with cancer and venous thromboembolism. J Clin Oncol. 2005 Apr 1;23(10):2123-9.
Meyer G, et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous
thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med. 2002 Aug 1226;162(15):1729-35.
NCCN guidelines: http://www.nccn.org/professionals/physician_gls/default.asp