International Guidelines 2022
Farge D, Frere C, Connors JM, Khorana AA, Kakkar A, Ay C, Munoz A, Brenner B, Prata PH, Brilhante D, Antic D, Casais P, Guillermo Esposito MC, Ikezoe T, Abutalib SA, Meillon-García LA, Bounameaux H, Pabinger I, Douketis J, and the International Initiative on Thrombosis and Cancer (ITAC) advisory panel.
Summary
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..
More about these guidelines
Despite the development of national clinical practice guidelines on VTE treatment in cancer patients, implementation of guidelines has been suboptimal worldwide and thus substantial knowledge gaps remain. ITAC-CME sought to establish a common international consensus addressing practical, clinically relevant questions in this setting. These updated recommendations also address thromboprophylaxis and treatment of VTE for patients with cancer and with COVID-19. The 2022 international guidelines provide recommendations for:
Treatment of established VTE
- Initial treatment of established VTE
- Early maintenance (up to 6 months) and long-term (beyond 6 months) treatment
- Treatment of VTE recurrence in patients with cancer on anticoagulant medication
- Treatment of established central venous catheter-related thrombosis
VTE prophylaxis
- Prophylaxis of VTE in patients with cancer undergoing surgery
- Prophylaxis of VTE in medically treated patients with cancer
- Prophylaxis of central venous catheter-related thrombosis
Special clinical situations
- VTE treatment in patients with brain tumours
- VTE treatment in in patients with cancer and thrombocytopenia
- VTE treatment in in patients with cancer and renal failure
- VTE treatment in pregnant patients with cancer
- VTE treatment in patients with cancer who are obese
Patients with cancer and with COVID-19