Overview of VTE treatment in cancer according to clinical guidelines

Evidence-based clinical practice guidelines are available to provide guidance to clinicians in managing patients living with cancer-associated venous thromboembolism (VTE). While most are developed using rigorous methods and grounded by systematic reviews of the literature, their recommendations do differ because of differences in their grading criteria and interpretation of the data. This can be confusing to practicing clinicians. Also, guidelines are often out of date and cannot keep pace with publications because of the lengthy processes and extensive resources required for completion. The most recent updates of major guidelines in the management of cancer-associated VTE were published in 2015-2016. They broadened the topics addressed in earlier versions but, similar to that in earlier documents, the quality of evidence remains weak in many important clinical scenarios, such as management of recurrent VTE, choice of anticoagulants for long-term and extended treatment, and duration of anticoagulant therapy. Consequently, many recommendations continue to reflect expert opinion and extrapolation from indirect data in non-cancer populations. This review summarizes and comments on the most recent guideline updates from the American College of Chest Physicians, the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the International Initiative on Thrombosis and Cancer. A new round of revisions is expected to incorporate the emerging data on the efficacy and safety of direct oral anticoagulants for the treatment of cancer-associated VTE.