Cancer · UKMLA & AKT
Peri-operative management of anticoagulation
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- First-line: apixaban (DOAC) - preferred over LMWH; oral, fewer bleeds, no frequent monitoring
- Duration: minimum 6 months for cancer-associated VTE; review ongoing need at 6 months based on cancer status
- DOACs in renal impairment: can be used if eGFR >30 (dose may need adjustment); CKD stage 3a (eGFR 45-59) - DOACs still appropriate
- LMWH - historically first-line for cancer VTE but now superseded by DOACs; renally cleared, given subcutaneously; use heparin (UFH) if significantly reduced renal function
- Warfarin - requires INR monitoring, unpredictable due to drug/diet interactions; not preferred in cancer-associated VTE
- Aspirin - antiplatelet only; no role in treating VTE
Thrombophilia screen is NOT indicated in cancer-associated VTE - the malignancy is the clear trigger. Do not delay treatment to screen.
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