Terms used in this guideline Active cancer įor a short explanation of why the committee made the 2020 recommendations on reviewing anticoagulation treatment and how they might affect practice, see rationale and impact.įull details of the evidence and the committee’s discussion are in: Review general health, risk of VTE recurrence, bleeding risk and treatment preferences at least once a year for people taking long-term anticoagulation treatment or aspirin. 1.4.11.įor people who decline continued anticoagulation treatment, consider aspirin 75 mg or 150 mg daily. If anticoagulation treatment fails follow the recommendation on treatment failure. įor people with renal impairment, active cancer, established triple positive antiphospholipid syndrome or extreme body weight (less than 50 kg or more than 120 kg), consider carrying on with the current treatment if it is well tolerated. If the current treatment is not well tolerated, or the clinical situation or person’s preferences have changed, consider switching to apixaban if the current treatment is a direct-acting anticoagulant other than apixaban. 1.4.8.įor people who do not have renal impairment, active cancer, established triple positive antiphospholipid syndrome or extreme body weight (less than 50 kg or more than 120 kg): Take into account the person’s preferences and their clinical situation when selecting an anticoagulant for long-term treatment. ![]() Discuss stopping anticoagulation if the HAS-BLED score is 4 or more and cannot be modified. 1.4.6.Ĭonsider using the HAS-BLED score to assess the risk of major bleeding in people having anticoagulation treatment for unprovoked proximal DVT or PE. 1.4.5.ĭo not rely solely on predictive risk tools to assess the need for long-term anticoagulation treatment. 1.4.4.Įxplain to people with unprovoked DVT or PE and a low bleeding risk that the benefits of continuing anticoagulation treatment are likely to outweigh the risks. Discuss the risks and benefits of long-term anticoagulation with the person, and take their preferences into account. Base the decision on the balance between the person’s risk of venous thromboembolism (VTE) recurrence and their risk of bleeding. Ĭonsider continuing anticoagulation beyond 3 months (6 months for people with active cancer) after an unprovoked DVT or PE. Information about out-of-hours services they can contact when their healthcare team is not available. 1.3.19.įor people with confirmed DVT or PE and cancer that is in remission, follow the recommendations in the section on anticoagulation treatment for confirmed DVT or PE. If a DOAC is unsuitable consider LMWH alone or LMWH concurrently with a VKA for at least 5 days, or until the INR is at least 2.0 in 2 consecutive readings, followed by a VKA on its own. 1.3.17.Ĭonsider a direct-acting oral anticoagulant (DOAC) for people with active cancer and confirmed proximal DVT or PE. When choosing anticoagulation treatment for people with active cancer and confirmed proximal DVT or PE, take into account the tumour site, interactions with other drugs including those used to treat cancer, and the person’s bleeding risk. For recommendations on treatment after 3 to 6 months see the section on long-term anticoagulation for secondary prevention. ![]() Review at 3 to 6 months according to clinical need. Offer people with active cancer and confirmed proximal DVT or PE anticoagulation treatment for 3 to 6 months. ![]() Anticoagulation treatment for DVT or PE with active cancer 1.3.15.
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