Chapter 10

VTE Prophylaxis

Fawzi Abu Rous, Manoj Rai*, Osama Mosalem, Layan El-khatib*, Calvin Abro and Abdullah Al-abcha


Cancer patients have an increased risk of VTE and its complications. It has been of utmost importance to identify high-risk patients. The Khorana score, which stratifies cancer patients into low and high risk, includes cancer type, chemotherapy regimen, hematological factors, and combinations of clinical and lab factors. In hospitalized cancer patients with limited mobility, pharmacologic prophylaxis with low molecular weight heparin (LMWH) or unfractionated heparin (UFH) is recommended. In those with contraindications to anticoagulation, mechanical prophylaxis can be used. In cancer patients undergoing surgery, perioperative VTE prophylaxis using pharmacologic anticoagulation is recommended, unless a minor procedure or an anticoagulant contraindication exists. In outpatients, the American Society of Clinical Oncology (ASCO) did not recommend routine anticoagulation in cancer patients except in high risk (e.g., Khorana score ≥2, or multiple myeloma, receiving thalidomide or lenalidomide). Those patients should be offered VTE prophylaxis with apixaban, rivaroxaban, or LMWH. Also, ASCO recommended periodic assessment of cancer patients for VTE risk and educating them about VTE's signs and symptoms.

Total Pages: 104-115 (12)

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