An American Society of Clinical Oncology update to the Clinical Practice Guideline for the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer includes the following:

• Thromboprophylaxis is generally required during hospitalization for patients with active cancer, but it is not recommended for outpatient treatment except in selected high-risk patients.

• Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low-molecular weight heparin (LMWH) or low-dose aspirin.

• Patients who are undergoing major surgery should receive prophylaxis starting before surgery and continue for at least 7 to 10 days; up to 4 weeks in those undergoing major abdominal or pelvic surgery with high-risk features.

• LMWH is recommended for the first 5 to 10 days of treatment for deep vein thrombosis or pulmonary embolism and for long-term secondary prevention of at least 6 months.

• Novel oral anticoagulants are not recommended for patients with malignancy and VTE at this time.

• Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications.

• Patients should be periodically assessed for VTE risk and educated about the signs and symptoms of VTE.

Citation: Lyman GH, Bohlke K, Khorana AA, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update 2014. J Clin Oncol. 2015. pii: JCO.2014.59.7351.