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  • NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)

    Cancer-Associated Venous Thromboembolic Disease

    Version 1.2017 — June 23, 2017

    Continue

    NCCN.org

    Version 1.2017, 06/23/17 © National Comprehensive Cancer Network, Inc. 2017, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

    http://www.nccn.org/default.aspx

  • NCCN Guidelines Index Table of Contents

    Discussion

    NCCN Guidelines Version 1.2017 Panel Members Cancer-Associated Venous Thromboembolic Disease

    *Michael B. Streiff, MD/Chair ‡ The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

    Bjorn Holmstrom, MD Þ/Vice-Chair Moffitt Cancer Center

    Aneel Ashrani, MD ‡ Mayo Clinic Cancer Center

    Paula L. Bockenstedt, MD ‡ University of Michigan Comprehensive Cancer Center

    Carolyn Chesney, MD ‡ St. Jude Children’s Research Hospital/ The University of Tennessee Health Science Center

    John Fanikos, RPH, MBA Σ Dana-Farber/Brigham and Women’s Cancer Center

    Randolph B. Fenninger, JD ¥ National Blood Clot Alliance

    Annemarie E. Fogerty, MD ‡ † Massachusetts General Hospital Cancer Center

    Shuwei Gao, MD Þ The University of Texas MD Anderson Cancer Center

    Samuel Z. Goldhaber, MD λ Dana-Farber/Brigham and Women’s Cancer Center

    Krishna Gundabolu, MD ‡ Fred & Pamela Buffett Cancer Center Paul Hendrie, MD, PhD ‡ Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance

    Alfred Lee, MD, PhD ‡ Yale Cancer Center/Smilow Cancer Hospital

    Jason T. Lee, MD ¶ λ Stanford Cancer Institute

    Janelle Mann, MD Σ Siteman Cancer Center at Barnes-Jewish Hospital and Washington Unviersity School of Medicine

    Brandon McMahon, MD ‡ University of Colorado Cancer Center

    Michael M. Millenson, MD ‡ Þ † Fox Chase Cancer Center

    Lalitha Nayak, MD, DO, PhD, RN ‡ Case Comprehensive Cancer Center/ University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute

    Thomas L. Ortel, MD, PhD ‡ Duke Cancer Institute

    Sadat Ozair, MD ‡ Roswell Park Cancer Institute

    Rita Paschal, MD ‡ University of Alabama at Birmingham Comprehensive Cancer Center

    Sanford Shattil, MD ‡ UC San Diego Moores Cancer Center

    Tanya Siddiqi, MD ‡ City of Hope Comprehensive Cancer Center

    Kristi J. Smock, MD ‡ ≠ Huntsman Cancer Institute at the University of Utah

    Gerald Soff, MD ‡ Memorial Sloan Kettering Cancer Center

    Tzu-Fei Wang, MD ‡ The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute

    Eliot Williams, MD ‡ University of Wisconsin Carbone Cancer Center

    Anaadriana Zakarija, MD ‡ Robert H. Lurie Comprehensive Cancer Center of Northwestern University

    NCCN Anita Engh, PhD Karin G. Hoffmann, RN, CCM

    Continue

    NCCN Guidelines Panel Disclosures

    ϕ Anesthesiology ¶ Surgery/Surgical oncology ‡ Hematology/Hematology oncology Σ Pharmacology/Pharmacy † Medical oncology λ Cardiology Þ Internal medicine # Nursing ¥ Patient advocacy ≠ Pathology *Discussion section writing member

    Version 1.2017, 06/23/17 © National Comprehensive Cancer Network, Inc. 2017, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

    Printed by Anton Kabakov on 3/5/2018 7:04:23 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved.

    http://www.nccn.org/professionals/physician_gls/f_guidelines.asp http://www.nccn.org/disclosures/panel_list.asp?ID=97

  • Clinical Trials: NCCN believes that the best management for any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged. To find clinical trials online at NCCN Member Institutions, click here: nccn.org/clinical_trials/physician.html. NCCN Categories of Evidence and Consensus: All recommendations are category 2A unless otherwise specified. See NCCN Categories of Evidence and Consensus.

    NCCN Cancer-Associated Venous Thromboembolic Disease Panel Members Summary of the Guidelines Updates Inpatient Venous Thromboembolism Prophylaxis (VTE-1) Acute Superficial Vein Thrombosis (SVT-1) Acute Deep Vein Thrombosis (DVT-1) Acute Pulmonary Embolism (PE-1) Heparin-Induced Thrombocytopenia (HIT-1) Splanchnic Vein Thrombosis (SPVT-1) VTE Risk Factors in Cancer Patients with Cancer (VTE-A) Contraindications to Prophylactic or Therapeutic Anticoagulation Treatment and Contraindications to Mechanical Prophylaxis (VTE-B) Management of Anticoagulation for VTE Patients with Chemotherapy-Induced Thrombocytopenia (VTE-C) Inpatient/Outpatient Prophylactic Anticoagulation Treatment (VTE-D) Therapeutic Anticoagulation for Venous Thromboembolism (VTE-E) Reversal of Anticoagulation (VTE-F) Elements for Consideration in Decision Not to Treat (VTE-G) Therapeutic Anticoagulation Failure (VTE-H) Thrombolytic Agents (VTE-I) Contraindications to Thrombolysis and Indications for Thrombolysis (VTE-J) Perioperative Management of Anticoagulation and Antithrombotic Therapy (PMA-1) Bleeding Risk Assessment Table (PMA-A) Thromboembolic Risk Assessment for Arterial and Venous Thromboembolism (PMA-B) Perioperative Anticoagulation Management Guideline (PMA-C) The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2017.

    NCCN Guidelines Version 1.2017 Table of Contents Cancer-Associated Venous Thromboembolic Disease

    NCCN Guidelines Index Table of Contents

    Discussion

    Version 1.2017, 06/23/17 © National Comprehensive Cancer Network, Inc. 2017, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

    Printed by Anton Kabakov on 3/5/2018 7:04:23 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved.

    http://www.nccn.org/clinical_trials/clinicians.aspx http://www.nccn.org/clinical_trials/clinicians.aspx http://www.nccn.org/professionals/physician_gls/f_guidelines.asp

  • NCCN Guidelines Index Table of Contents

    Discussion

    UPDATES 1 OF 5

    NCCN Guidelines Version 1.2017 Updates Cancer-Associated Venous Thromboembolic Disease

    Continued

    Updates in Version 1.2017 of the NCCN Guidelines for Cancer-Associated Venous Thromboembolic Disease from Version 1.2016 include:

    Venous Thromboembolism VTE-1 • Initial Prophylaxis �"Graduated compression stockings" were removed as an option for

    initial prophylaxis. �Footnote "b" was revised: "See Contraindications to Prophylactic or

    Therapeutic Anticoagulation Treatment (VTE-B). See Management of Anticoagulation for VTE in Patients with Chemotherapy-Induced Thrombocytopenia (VTE-C)" (Also for DVT-2, DVT-3, PE-2, and SPVT-2)

    �Footnote “d” was revised: “IPC device is preferred over GCS. Patients should be appropriately measured for stockings and monitored for adverse effects including skin ulcerations, especially in immobilized patients with peripheral neuropathy. See Contraindications to Mechanical Prophylaxis (VTE-B). (CLOTS Trial Collaboration. Lancet 2009. 373:1958 1965.) In contrast to GCS, IPC significantly reduced DVT and was associated with a lower risk of skin complications. (CLOTS Trial Collaboration Dennis M, et al. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet 2013;382:516-524, and Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet 2009;373:1958-1965.)"

    SVT-1 • “Acute Superficial Vein Thrombosis (SVT)” was extensively revised. Acute Deep Vein Thrombosis (DVT) DVT-1 • Diagnosis �Pathway statement was revised: “Incidental Unsuspected DVT”

    (Also for PE-1) • Workup/Imaging �For workup of "Incidental DVT" (bottom pathway), footnote “a” was

    removed from venous ultrasound: “In cases with high suspicion of DVT and no contraindications, consider initiating early anticoagulation while awaiting imaging results,” and was replaced with new footnote "b": "If initial imaging results inconclusive, consider venous ultrasound to confirm diagnosis."

    Version 1.2017, 06/23/17 © National Comprehensive Cancer Network, Inc. 2017, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

    DVT-1 continued • Addi

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