The in-hospital treatment guidelines ask doctors to determine if the patient is suffering from deep vein thrombosis (DVT) or if the patient is at risk of the condition because of a cancer diagnosis or a suspicion of cancer, said Lawrence Wagman, MD, Chairman and Emeritus Professor of Surgery, City of Hope Cancer Center, Duarte, California, United States.

Dr. Wagman said the writers of the guideline reviewed various trials of anticoagulation agents and determined that, generally speaking, all were about the same in effectiveness.

"We suggest that doctors select an agent based on cost effectiveness and patient conditions," he said during his presentation on March 11^th.

That algorithm lists the following agents for anticoagulation:

- Unfractionated heparin: 5,000 U subcutaneously three times a day.
- Low molecular weight heparin, dosed according to standard operating procedures of individual institutions, with either dalteparin, enoxaparin or tinzaparin.
- Pentasaccharide, fondaparinux, 2.5 mg subcutaneous daily.

Actually three guidelines were developed: One for the prophylaxis of venous thromboembolism in patients with cancer or who are suspected of cancer; a second for patients with DVT; and a third for patients who experience pulmonary emboli.

If patients have contraindications for anticoagulation, compression devices can be utilized, including graduated compression stockings.

The guidelines suggest the use of low molecular weight heparin for long-term therapy for prevention of recurrent DVT in patients with advanced or metastatic cancer. The minimum time for treatment of DVT is 3 to 6 months and 6 months to 12 months for pulmonary embolism.

"We have known for more than 150 years that cancer is linked to venous thromboembolism," said Michael Streiff, MD, Assistant Professor of Medicine-Hematology, Johns Hopkins University, Baltimore, Maryland, United States. "Cancer increased the risk of deep vein thrombosis by 4 to 7 times over people who do not have cancer."

Doctors from the 19 member institutions of the NCCN have been developing guidelines for treatment of cancer and associated symptoms since 1996. The guidelines have been adopted by hundreds of other hospitals across the country.


[Presentation title: Venous Thromboembolic Disease.]

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