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      DOACs and “newer” hemophilia therapies in COVID‐19: Reply

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          Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

          PURPOSE To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. METHODS PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommendations as needed. RESULTS The systematic review included 35 publications on VTE prophylaxis and treatment and 18 publications on VTE risk assessment. Two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in patients with cancer reported that edoxaban and rivaroxaban are effective but are linked with a higher risk of bleeding compared with low-molecular-weight heparin (LMWH) in patients with GI and potentially genitourinary cancers. Two additional RCTs reported on DOACs for thromboprophylaxis in ambulatory patients with cancer at increased risk of VTE. RECOMMENDATIONS Changes to previous recommendations: Clinicians may offer thromboprophylaxis with apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban and edoxaban have been added as options for VTE treatment; patients with brain metastases are now addressed in the VTE treatment section; and the recommendation regarding long-term postoperative LMWH has been expanded. Re-affirmed recommendations: Most hospitalized patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE. Additional information is available at www.asco.org/supportive-care-guidelines .
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            Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism

            Low-molecular-weight heparin is the standard treatment for cancer-associated venous thromboembolism. The role of treatment with direct oral anticoagulant agents is unclear.
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              Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer

              Recent guidelines recommend consideration of the use of oral edoxaban or rivaroxaban for the treatment of venous thromboembolism in patients with cancer. However, the benefit of these oral agents is limited by the increased risk of bleeding associated with their use.
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                Author and article information

                Journal
                J Thromb Haemost
                J Thromb Haemost
                Journal of Thrombosis and Haemostasis
                International Society on Thrombosis and Haemostasis. Published by Elsevier Inc.
                1538-7933
                1538-7836
                21 December 2022
                July 2020
                21 December 2022
                : 18
                : 7
                : 1795-1796
                Affiliations
                [1 ]Department of Haematology, Manchester University Hospitals, Manchester, UK
                [2 ]Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
                [3 ]Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
                [4 ]Department of Transfusion Medicine and Hematology, Hospital Papa Giovanni, XXIII, Bergamo, Italy
                [5 ]University of Milan Bicocca, Bergamo, Italy
                [6 ]ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
                [7 ]Department of Medicine and Cardio‐metabolic Programme‐NIHR UCLH/UCL BRC, University College London Hospitals NHS Foundation Trust, London, UK
                [8 ]Director of Programs and Education, International Society on Thrombosis and Haemostasis, Carrboro, North Carolina
                [9 ]Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
                Author notes
                [* ] CorrespondenceJecko Thachil, Department of Haematology, Manchester Royal Infirmary, Oxford road, Manchester, M13 9WL, UK.
                Article
                S1538-7836(22)01342-3
                10.1111/jth.14841
                9770941
                32282993
                f881f60f-4291-4570-86e6-0f9eddba460b
                Copyright © 2020 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 8 April 2020
                : 8 April 2020
                Categories
                Letter to the Editor

                Hematology
                anticoagulant,covid-19,thrombosis
                Hematology
                anticoagulant, covid-19, thrombosis

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