2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

Overview

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a frequent and serious complication in people with cancer. It is a leading cause of morbidity and death in this population. These 2022 international clinical practice guidelines, developed by the International Initiative on Thrombosis and Cancer, update earlier editions. They cover treatment, prophylaxis and special clinical situations, and they address patients with cancer who also have COVID-19.

Treatment

The guidelines give recommendations for the initial, early maintenance and long-term treatment of cancer-associated VTE. The choice among anticoagulant options is based on efficacy and bleeding risk, tumour type and location, drug interactions with anticancer therapy, kidney function and patient preference. Recommendations also cover how long to continue anticoagulation, managing recurrence, and catheter-related thrombosis.

Prophylaxis

Thromboprophylaxis is addressed for surgical patients with cancer, hospitalised medical patients and ambulatory patients receiving systemic anticancer therapy. For outpatients, the guidelines support individual risk assessment to identify people most likely to benefit from preventive anticoagulation.

Special situations

Specific guidance is provided for complex scenarios, including thrombocytopenia, kidney impairment, brain tumours, and children with cancer. For patients with cancer and COVID-19, the recommendations cover assessing thrombotic and bleeding risk and preventing VTE in hospital and outpatient settings.

Clinical implications

The guidelines help oncologists, haematologists and other clinicians balance thrombotic and bleeding risks in a complex population. They emphasise individualised decisions, regular reassessment and involving patients in treatment choices.