This handout is for incidental dvt on cancer-staging imaging. Your care team identified this based on: incidental dvt noted on ct chest/abdomen/pelvis ordered for cancer staging or restaging — patient asymptomatic in the involved limb.
Other reasons your team may use this plan: incidental dvt on surveillance mri for known malignancy; catheter-associated upper-extremity dvt noted on chest ct in patient with picc or port for active chemotherapy; ivc tumor thrombus extension (renal cell, hcc, adrenal cortical) with associated bland-thrombus dvt.
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 per API-CAT for active cancer) | CARAVAGGIO (Agnelli NEJM 2020 PMID 32223112) — apixaban non-inferior to dalteparin LMWH with similar major bleed in non-mucosal cancer; ACCP 2021 + ITAC 2022 first-line for incidental as for symptomatic 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; higher GI bleed in luminal GI 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 CRNMB; 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 per ITAC 2022 |
| 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 |
Plan: Incidental cancer-associated DVT — same therapeutic AC as symptomatic; DOAC vs LMWH per cancer type (ACCP 2021 + ITAC 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 per ITAC 2022 (indefinite while active); API-CAT 2024 extended apixaban (months 7–18) reasonable per PMID 38780119; reassess at 12 mo + ongoing per cancer status; stop only when cancer in durable remission ≥1 yr AND minimum 6 mo AC complete; for catheter-associated UEDVT — continue AC for catheter retention duration plus minimum 3 mo
Guideline: ACCP/CHEST 2021 + ITAC-CME 2022 + ASH 2021 Cancer-VTE