Article Synopsis
- The ASCO updated its guidelines on venous thromboembolism (VTE) to include new recommendations based on recent clinical trial findings.
- Five randomized controlled trials (RCTs) were analyzed to assess the effectiveness of direct factor Xa inhibitors, particularly apixaban and rivaroxaban, for both postoperative thromboprophylaxis and VTE treatment.
- The updated guidelines weakly recommend apixaban and rivaroxaban for extended thromboprophylaxis after cancer surgery and strongly recommend apixaban for treating VTE due to its effectiveness and low risk of major bleeding.
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Article Abstract
Purpose: To conduct an update of the ASCO venous thromboembolism (VTE) guideline.
Methods: After publication of potentially practice-changing clinical trials, identified through ASCO's signals approach to updating, an updated systematic review was performed for two guideline questions: perioperative thromboprophylaxis and treatment of VTE. PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) published between November 1, 2018, and June 6, 2022.
Results: Five RCTs provided information that contributed to changes to the 2019 recommendations. Two RCTs addressed direct factor Xa inhibitors (either rivaroxaban or apixaban) for extended thromboprophylaxis after surgery. Each of these postoperative trials had important limitations but suggested that these two oral anticoagulants are safe and effective in the settings studied. An additional three RCTs addressed apixaban in the setting of VTE treatment. Apixaban was effective in reducing the risk of recurrent VTE, with a low risk of major bleeding.
Recommendations: Apixaban and rivaroxaban were added as options for extended pharmacologic thromboprophylaxis after cancer surgery, with a weak strength of recommendation. Apixaban was also added as an option for the treatment of VTE, with high quality of evidence and a strong recommendation.Additional information is available at www.asco.org/supportive-care-guidelines.
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| http://dx.doi.org/10.1200/JCO.23.00294 | DOI Listing |
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