International recommendations for the prevention and treatment of venous thromboembolism associated with cancer.

Venous thromboembolism (VTE) is a common complication and a leading cause of death in oncological patients. Recent guidelines have been established for the treatment and prevention of VTE in oncological patients in various clinical situations. These guidelines recommend: (a) prophylactic anticoagulation in all hospitalized oncological patients in whom there are no contraindications; (b) prophylactic anticoagulation in patients scheduled for major oncological surgery in whom there are no contraindications; (c) prolonged (>or=6 months) anticoagulant therapy in oncological patients with manifest VTE in order to prevent a new episode; (d) no routine prophylactic anticoagulation in ambulatory patients without VTE receiving chemotherapy, except when they are receiving treatment with anti-cancer agents with a high risk of thrombogenicity, such as thalidomide- or lenalidomide-based chemotherapeutic regimens; and (e) no use of prophylactic anticoagulants to improve survival in patients with cancer without manifest VTE. Although vitamin K antagonists, unfractionated heparin and in some cases fondaparinux sodium could be used for the treatment of VTE, low molecular weight heparins are recommended for initial and continuous anticoagulant treatment in oncological patients with VTE, as well as for its prevention.