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American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer

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Paper Summary

Paperzilla title
To Clot or Not to Clot: ASH's Guide to VTE Management in Cancer Patients

The guidelines recommend thromboprophylaxis for hospitalized medical and surgical cancer patients at high risk for VTE and low risk for bleeding, using LMWH or DOACs in various settings. They also emphasize individualized treatment decisions based on patient-specific factors, balancing the risk of VTE recurrence with bleeding complications.

Explain Like I'm Five

Scientists found that for very sick people with cancer, doctors often give special medicine to stop their blood from getting too sticky and causing problems. They decide the best medicine for each person so they get better without new issues.

Possible Conflicts of Interest

Most members of the guideline panel were members of ASH, the funding organization. Two panelists disclosed direct financial conflicts with affected companies after recommendations were formed, but the oversight committee determined that these were unlikely to have influenced the guidelines.

Identified Limitations

Indirectness of Evidence
The guideline relies heavily on indirect evidence due to the limited availability of studies specifically focusing on cancer patients in some scenarios. This limits the applicability of the guidelines to specific cancer populations.
Low Certainty of Evidence
Many recommendations are based on low or very low certainty evidence, highlighting the uncertainty surrounding the effects of different interventions. This calls for more research to strengthen the evidence base.
Variability in Cost-Effectiveness
The guideline acknowledges the variability in cost-effectiveness across different healthcare settings and resource availability. This makes it challenging to apply the economic considerations universally.
Limited Guidance on Shared Decision-Making
The guideline emphasizes the importance of shared decision-making, recognizing that patient values and preferences regarding treatment outcomes may vary. However, it doesn't provide specific tools or guidance on how to effectively incorporate these factors in clinical practice.

Rating Explanation

This guideline provides comprehensive and evidence-based recommendations for VTE prevention and treatment in cancer patients, addressing a significant clinical problem. While many recommendations are based on low-certainty evidence, the guidelines follow a rigorous methodology (GRADE) and incorporate important considerations like patient values and cost-effectiveness. The identified COIs are acknowledged and were judged to be unlikely to have significantly biased the recommendations.

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Topic Hierarchy

Domain: Health Sciences
Field: Medicine
Subfield: Internal Medicine

File Information

Original Title: American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer
Uploaded: July 14, 2025 at 10:31 AM
Privacy: Public