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Huyen Nguyen: Highlights from the NCCN Cancer-Associated Venous Thromboembolic Disease Guidelines

Huyen Nguyen/LinkedIn

Jun 7, 2026, 15:18

Huyen Nguyen: Highlights from the NCCN Cancer-Associated Venous Thromboembolic Disease Guidelines

Huyen Nguyen, Clinical Pharmacist at Vinmec Healthcare System, shared on LinkedIn:

”NCCN Cancer-Associated Venous Thromboembolic Disease Guidelines Version 1.2026

Venous thromboembolism (VTE) remains one of the most common and potentially life-threatening complications in patients with cancer.

It is associated with increased morbidity, treatment interruptions, hospitalisations, and mortality.

Some important clinical updates and reminders:

Cancer increases the risk of VTE several-fold compared with the general population, making risk assessment an essential component of routine oncology care.
The Khorana Score remains one of the most validated tools for identifying ambulatory patients at high risk for chemotherapy-associated thrombosis.
Direct oral anticoagulants (DOACs), including apixaban and rivaroxaban, are increasingly used for both thromboprophylaxis and treatment of cancer-associated thrombosis in appropriately selected patients.
Extended thromboprophylaxis should be considered following major abdominal or pelvic cancer surgery in patients at high risk of postoperative VTE.
Catheter-related thrombosis can often be managed with anticoagulation without immediate catheter removal when the device remains functional and clinically necessary.

Some practical clinical pearls:

Assess thrombosis and bleeding risk before initiating anticoagulation
Review renal function, hepatic function, platelet count, and drug interactions regularly
Consider LMWH in selected patients with severe thrombocytopenia, gastrointestinal malignancies, genitourinary cancers, or concerns regarding DOAC absorption
Evaluate interactions with targeted therapies, azole antifungals, anticonvulsants, and other CYP/P-gp modulators
Reassess anticoagulation needs periodically as cancer status, treatment plans, and bleeding risks evolve
Remember that active cancer often represents a persistent thrombotic risk factor, and anticoagulation beyond 3 months may be appropriate for selected patients

Another important reminder:

Optimal management of cancer-associated thrombosis requires multidisciplinary collaboration among oncologists, hematologists, pharmacists, surgeons, nurses, and thrombosis specialists to maximize efficacy while minimizing bleeding complications.”

Huyen Nguyen: Highlights from the NCCN Cancer-Associated Venous Thromboembolic Disease Guidelines