Cancer-associated thromboembolism
Why cancer clots, the Khorana score and outpatient prophylaxis (AVERT, CASSINI), choosing a DOAC or LMWH for treatment (Caravaggio, Hokusai, SELECT-D), duration, thrombocytopenia, brain tumours, catheter clots and recurrence on anticoagulation.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Cancer raises VTE risk 4 to 7-fold, and VTE is the second commonest cause of death in people with cancer after the cancer itself.
- Risk is highest in the first 3 to 6 months after diagnosis, with metastatic disease, and with pancreatic, gastric, brain, lung and ovarian cancer, lymphoma and myeloma.
- Outpatient prophylaxis is offered to patients starting systemic therapy with a Khorana score of 2 or more and low bleeding risk.
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Sources
- Tran HA et al. New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism. Med J Aust 2019;210:227-35AU/NZTHANZ (Medical Journal of Australia), 2019
- Therapeutic Guidelines: Cardiovascular (venous thromboembolism)AU/NZTherapeutic Guidelines Ltd
- Key NS et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update. J Clin Oncol 2023;41:3063-71American Society of Clinical Oncology, 2023 (current, November 2026)
- Falanga A et al. Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline. Ann Oncol 2023;34:452-67ESMO, 2023
- Farge D et al. 2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer (ITAC). Lancet Oncol 2022;23:e334-47International Initiative on Thrombosis and Cancer, endorsed by ISTH, 2022
- Samuelson Bannow BT et al. Management of cancer-associated thrombosis in patients with thrombocytopenia: guidance from the SSC of the ISTH. J Thromb Haemost 2018;16:1246-9International Society on Thrombosis and Haemostasis, 2018
- Khorana AA et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902-7Blood, 2008
- Carrier M et al. Apixaban to prevent venous thromboembolism in patients with cancer (AVERT). N Engl J Med 2019;380:711-9New England Journal of Medicine, 2019
- Khorana AA et al. Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer (CASSINI). N Engl J Med 2019;380:720-8New England Journal of Medicine, 2019
- Lee AYY et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer (CLOT). N Engl J Med 2003;349:146-53New England Journal of Medicine, 2003
- Raskob GE et al. Edoxaban for the treatment of cancer-associated venous thromboembolism (Hokusai VTE Cancer). N Engl J Med 2018;378:615-24New England Journal of Medicine, 2018
- Young AM et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism (SELECT-D). J Clin Oncol 2018;36:2017-23Journal of Clinical Oncology, 2018
- Agnelli G et al. Apixaban for the treatment of venous thromboembolism associated with cancer (Caravaggio). N Engl J Med 2020;382:1599-607New England Journal of Medicine, 2020
- Mahé I et al. Extended reduced-dose apixaban for cancer-associated venous thromboembolism (API-CAT). N Engl J Med 2025;392:1363-73New England Journal of Medicine, 2025
- Last updated
- 14 November 2026
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