NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Venous Thrombosis in Patients with Malignant Disease

Treatment and Secondary Prophylaxis of Venous Thrombosis in Patients with Malignant Disease


The NHSGGC guideline for treatment and secondary prophylaxis of venous thrombosis (VTE) in patients with malignant disease has been reviewed and updated.

The most recent version includes new dosing advice for patients who weigh >99kg.

Key points

  • VTE in patients with active cancer and/or receiving active systemic anticancer treatment is most effectively treated with LMWH rather than warfarin or DOACs. The guideline recommends the use of dalteparin in this patient group.
  • After the first month of full dalteparin treatment dose, the dose should be reduced by 25% (i.e. patients should receive 75% of full treatment dose). Patients who weigh >99kg should remain on dalteparin 18,000 units for the duration of treatment.
  • Treatment with dalteparin should be continued for a minimum of 6 months at which point the need for a LMWH should be reviewed.
  • Beyond 6 months the choice of anticoagulant should be based on the continued presence of cancer, ongoing active systemic anticancer treatment, bleeding risk, quality of life, patient preference and life expectancy.
  • If started during hospital admission, an anticoagulant treatment plan should be detailed in the discharge letter.


Published 30/06/2017