This handout is for cancer-associated dvt (cat). Your care team identified this based on: active cancer (treatment within 6 months or metastatic) with new dvt → cancer-associated thrombosis (cat).
Other reasons your team may use this plan: cancer diagnosed within preceding 6 months — cat phenotype regardless of current treatment status; unprovoked dvt in patient age ≥50 → trigger occult cancer screening per some (pmid 26095396); convert to cat pathway if cancer found.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| apixaban | 10 mg BID × 7 d → 5 mg BID | PO | BID × 6 months minimum (extend to 12 mo per API-CAT 2024) | CARAVAGGIO (Agnelli NEJM 2020 PMID 32223112) — apixaban non-inferior to dalteparin LMWH with similar major bleed in non-mucosal cancer; ISTH 2022 first-line for non-mucosal CAT |
| edoxaban | 60 mg daily after 5 d LMWH lead-in (30 mg if CrCl 15-50 or weight ≤60 kg) | PO | daily × 6 months minimum | Hokusai-Cancer (Raskob NEJM 2018 PMID 29231094) — edoxaban non-inferior to dalteparin; higher GI bleed in luminal GI cancer subgroup |
| rivaroxaban | 15 mg BID × 21 d → 20 mg daily | PO | BID then daily × 6 months | SELECT-D (Young JCO 2018 PMID 29746227) — rivaroxaban reduces recurrent VTE vs dalteparin but increases clinically relevant non-major bleeding; AVOID in GI/GU cancer per subgroup |
| dalteparin | 200 IU/kg SC daily × 1 month → 150 IU/kg SC daily | SC | daily × 6 months | CLOT (Lee NEJM 2003 PMID 12853587) — landmark establishing LMWH > VKA in cancer-VTE; remains first-line in mucosal cancers |
| enoxaparin | 1 mg/kg SC BID; reduce to 1 mg/kg daily if CrCl <30 | SC | BID | ASH 2018 in pregnancy; reasonable LMWH alternative to dalteparin |
| warfarin | 5 mg daily; INR target 2-3 | PO | daily | CLOT showed VKA inferior to LMWH in cancer-VTE; warfarin is last-line option |
Plan: Cancer-associated thrombosis (CAT) anticoagulation — DOAC vs LMWH per cancer type (ISTH 2022)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
6-month landmark: continue AC if cancer active OR API-CAT 2024 extended apixaban (months 7-18) for active cancer (PMID 38780119); reassess at 12 mo and beyond per cancer status; stop only when cancer in durable remission
Guideline: ISTH 2022 Cancer-VTE + ASH 2021 Cancer-VTE + ACCP/CHEST 2021