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Symptom Management and Supportive Care

The NCCN Clinical Practice Guidelines on Venous Thromboembolic Disease: Strategies for Improving VTE Prophylaxis in Hospitalized Cancer Patients

James P. Wilmot Cancer Center, University of Rochester, Rochester, New York, USA

Key Words. Venous thromboembolism • Cancer • Anticoagulation • Prophylaxis • Clinical practice guideline

Correspondence: Alok A. Khorana, M.D., James P. Wilmot Cancer Center, University of Rochester, 601 Elmwood Ave, Box 704, Rochester, New York 14642, USA. Telephone: 585-275-4797; Fax: 585-273-1042; e-mail: alok_khorana{at}URMC.rochester.edu

Disclosure: Financial and editorial support for this publication has been provided by Sanofi-Aventis US Inc. The author, however, was fully responsible for content and editorial decisions for this manuscript. A.A.K. is supported by grant 1K23 CA120587–01A1 from the National Cancer Institute. A.A.K. has acted as a consultant to and has received speaker's honoraria from Sanofi-Aventis. He has received research support to his institution from Pfizer Inc. and Bristol-Myers Squibb. No conflicts of interest were reported by the planners, reviewers, or staff managers of this article.

The risk for venous thromboembolism (VTE) is high in hospitalized cancer patients, and is associated with an elevated risk for recurrent thrombosis, bleeding complications, and use of health care resources. Thromboembolism is the second leading cause of death in hospitalized cancer patients. Thromboprophylaxis with unfractionated heparin or low-molecular-weight heparins has been clinically proven to reduce the risk for VTE and improve outcomes. However, VTE prophylaxis continues to be underprescribed in cancer patients. Recognizing the clinical burden of VTE in cancer patients, the National Comprehensive Cancer Network (NCCN) recently released guidelines for VTE prevention and management. These NCCN guidelines recommend evidence-based prophylactic anticoagulant therapy for all patients admitted to hospital with a diagnosis of cancer who do not have contraindications to anticoagulant use. However, there continue to be barriers to the implementation of clinical practice guidelines and appropriate use of VTE prophylaxis. Multifaceted active educational and electronic interventions are necessary to raise awareness and reduce the burden of cancer-associated thrombosis and its attendant consequences.