Clot shot.

ASCO has updated their guidelines on venous thromboembolism (VTE) prophylaxis and treatment. What hasn’t changed? Without clear, commonsense contraindications, pretty much all patients with active cancer who are hospitalized for an acute medical condition (read: NOT for a simple chemo infusion) or undergoing “major” surgery (read: NOT something like a port placement) should receive prophylaxis. And that prophylaxis should be either tried and true heparin or a much more expensive but orally administered factor Xa inhibitor. All other patients should receive prophylaxis based on risk, specifically with a Khorana score ≥2. What has changed? Several factor Xa inhibitors are now heavily vetted for both prophylaxis and treatment of VTE, and there is now a clarification that the simple presence of primary or metastatic brain tumors is not an absolute contraindication for anticoagulants. In fact, recent data suggests the benefits likely outweigh the risks for patients with brain tumors in accordance with recs for other sites. TBL: Data supports VTE prophylaxis and treatment in more patients than you probably think, and that doesn’t have to mean heparin. | Key, J Clin Oncol 2019

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