Column Introduction:

The medical field is evolving rapidly. Precise and authoritative clinical guidelines not only signal changes in diagnostic and treatment standards but also influence global medication choices.

HepaVanguard is a newly established content column by Hepalink Pharmaceutical, focusing on global guideline updates, research progress, and market approval dynamics for heparin-based drugs. We are committed to tracking information at its source and distilling key insights to present—in a clear and readable manner—the real-world advancements of heparin in the global therapeutic landscape.

We invite you to follow this column as we explore the logic behind guideline evolution, grasp the frontier consensus on medication choices, and expand the boundaries of our understanding of heparin's clinical value.

In the field of oncology, Venous Thromboembolism (VTE) is one of the most common yet frequently overlooked complications. It not only impacts the treatment process but can also directly threaten a patient's life. Scientific and standardized prevention and treatment of VTE have become a continuous focus of global clinical practice.

Recently, the National Comprehensive Cancer Network (NCCN) released the Clinical Practice Guidelines in Oncology: Cancer-Associated Venous Thromboembolic Disease (Version 3.2025). This version includes updates in several key areas, providing clearer recommendations regarding the scope of use, dosage, and recommendations for enoxaparin.

This article provides a quick overview of the core content of these authoritative guidelines to help clarify the latest strategies for VTE prevention and treatment.

Which Patients Require VTE Prevention? The Guidelines Give a Clear Answer

Cancer itself increases the risk of thrombosis, particularly during hospitalization, post-surgery, or while undergoing systemic therapy. The new NCCN guidelines refine the target population for VTE prevention as follows:

• Inpatient Cancer Patients (excluding those with basal/squamous cell carcinoma of the skin): Routine VTE prevention is suggested.
• Post-discharge Patients after Abdominal/Pelvic Cancer Surgery: For high-risk groups, continued prophylaxis after discharge is suggested, with a duration of up to 4 weeks.
• Ambulatory Medical Oncology Patients receiving Systemic Therapy (excluding multiple myeloma, acute leukemia, myeloproliferative neoplasms, and primary/metastatic brain tumors): The need for prophylaxis depends on the Khorana Score:

Score ≥ 2: Moderate to high risk; anticoagulation prophylaxis may be considered for a duration of up to 6 months or longer.

Score < 2: Low risk; routine prophylaxis is generally not needed.

Note: The Khorana Score is clinically used to assess the risk level of VTE in cancer patients, taking into account factors such as tumor type, platelet count, and BMI.

Enoxaparin Remains a Core Drug Recommended by Guidelines

Regarding prophylactic medication, the NCCN continues to emphasize Low Molecular Weight Heparin (LMWH) as the preferred choice for inpatients. Among them, Enoxaparin, as a representative LMWH, is explicitly listed as a preferred or optional regimen in multiple scenarios:

Prophylaxis Scenario	Medication Options	Special Notes
Medical Inpatients	Unfractionated Heparin (UFH), Enoxaparin, Dalteparin, Fondaparinux	Preferred: LMWH, unless contraindicated (e.g., renal insufficiency)
Medical Outpatients / Post-discharge	Enoxaparin, Dalteparin, Apixaban, Rivaroxaban	/
Surgical Inpatients	Unfractionated Heparin (UFH), Enoxaparin, Dalteparin, Fondaparinux, Apixaban, Rivaroxaban	/
Surgical Post-discharge	Enoxaparin, Dalteparin, Apixaban, Rivaroxaban	/

For patients with renal insufficiency or extreme body weight (BMI ≥ 40 kg/m² or < 50 kg), the guidelines also provide individualized dosage adjustment recommendations for Enoxaparin, offering more precise references for clinical practice.

Updates in VTE Treatment Strategies: Enoxaparin Holds a Significant Position

The new guidelines suggest:

• Cancer patients without gastric or gastroesophageal lesions: Direct Oral Anticoagulants (DOACs) are preferred.
• Patients with gastric or gastroesophageal lesions: Low Molecular Weight Heparin (LMWH) is preferred, with a duration of at least 3 months or for the duration of active cancer or cancer treatment.

Recommended Therapeutic Dosage for Enoxaparin:

1 mg/kg, SC, every 12 hours (BMI < 40 kg/m²); OR 0.8 mg/kg, SC, every 12 hours (BMI ≥ 40 kg/m²). Consideration may be given to adjusting the dose to 1.5 mg/kg, SC, once daily after 1 month of use.

This dosage adjustment balances efficacy with compliance, reflecting the flexibility and safety of Enoxaparin in clinical use.

More Refined Perioperative Management: Evidence-Based Pause Times for Enoxaparin

Anticoagulation management during surgery requires striking a balance between "preventing thrombosis" and "controlling bleeding." The NCCN guidelines provide recommendations for preoperative stop times for Enoxaparin based on bleeding risk and renal function:

Dosage Regimen	Renal Function Status	Low Bleeding Risk	Intermediate/High Bleeding Risk
1 mg/kg every 12 hours	CrCl > 50 mL/min	Stop 12–24 hours prior	Stop 24 hours prior
0.8 mg/kg every 12 hours	CrCl 30–50 mL/min	Stop 24 hours prior	Stop 24–36 hours prior
1 mg/kg every 24 hours	CrCl < 30 mL/min	Stop 24 hours prior	Stop 24–48 hours prior

These recommendations provide clearer timepoints for clinical perioperative management, helping both clinicians and patients achieve controllable risks.

From prevention to treatment, and from hospitalization to post-operative management, Enoxaparin remains a cornerstone in the prevention and treatment of cancer-associated VTE, thanks to its excellent clinical performance, flexible usage regimens, and extensive guideline support.

As anticoagulation therapy continues to evolve, the updates to the NCCN guidelines not only provide more refined clinical guidance but also reflect the medical community's high regard for safety and individualized treatment.

As a global leader in the heparin field, Hepalink Pharmaceutical will continue to monitor updates in international therapeutic consensus. We are dedicated to serving global patient safety with superior products, professional insights, and timely information.

References:

NCCN Clinical Practice Guidelines in Oncology: Cancer-Associated Venous Thromboembolic Disease, Version 3.2025.