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Lancet Oncol. 2019 Oct;20(10):e566-e581. doi: 10.1016/S1470-2045(19)30336-5. Epub 2019 Sep 3.

2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer.

Author information

1
Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of Reference for Rare Systemic Autoimmune Diseases (FAI2R), Université de Paris, Paris, France; Department of Medicine, McGill University, Montreal, QC, Canada. Electronic address: itaccme@gmail.com.
2
Department of Haematology, Sorbonne Université, UMRS 1166, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
3
Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
4
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
5
Cleveland Clinic, Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland, OH, USA.
6
Medical Oncology Department, Hospital General Universitario Gregorio Maranon, Universidad Complutense, Madrid, Spain.
7
Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
8
Thrombosis Research Institute and University College London, London, UK.
9
Eurocord, Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Université de Paris, Paris, France.
10
Department of Medicine, McGill University, Montreal, QC, Canada.
11
Francisco Gentil Portuguese Institute of Oncology, Lisbon Center, Lisbon, Portugal.
12
Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Católica de Murcia, Badalona, Barcelona, Spain.
13
Division of Angiology and Hemostasis, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
14
Department of Medicine, McMaster University, Hamilton ON, Canada.

Abstract

Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at a high risk of VTE recurrence and bleeding during anticoagulant therapy. The International Initiative on Thrombosis and Cancer is an independent academic working group aimed at establishing a global consensus for the treatment and prophylaxis of VTE in patients with cancer. The International Initiative on Thrombosis and Cancer last updated its evidence-based clinical practice guidelines in 2016 with a free, web-based mobile phone application, which was subsequently endorsed by the International Society on Thrombosis and Haemostasis. The 2019 International Initiative on Thrombosis and Cancer clinical practice guidelines, which are based on a systematic review of the literature published up to December, 2018, are presented along with a Grading of Recommendations Assessment Development and Evaluation scale methods, with the support of the French National Cancer Institute. These guidelines were reviewed by an expanded international advisory committee and endorsed by the International Society on Thrombosis and Haemostasis. Results from head-to-head clinical trials that compared direct oral anticoagulant with low-molecular-weight heparin are also summarised, along with new evidence for the treatment and prophylaxis of VTE in patients with cancer.

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