The National Comprehensive Cancer Network (NCCN) recently issued guidelines recommending inpatient prophylactic anticoagulation therapy with unfractionated heparin, low-molecularweight heparin (LMWH), or fondaparinux. The guidelines do not address outpatient prophylaxis, but they suggest immediate and long-term treatment once an episode of venous thromboembolism (VTE) occurs. The NCCN recommends 3 to 6 months of treatment for deep vein thrombosis, 6 to 12 months of treatment for pulmonary embolism, and indefinite treatment for patients with active cancer or persistent risk factors.
The NCCN recommends the use of LMWH or warfarin for long-term treatment and secondary prevention. Preliminary data suggest an improved survival benefit using LMWH, however. The new guidelines may be accessed at www.nccn.org/professionals/physician_gls/sPDF/vte.pdf.
Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.