Arterial and venous thromboembolism

Acute Oncology Guidelines
NHS Lothian
  • No increased incidence of venous thromboembolism in patients receiving VEGF-i therapy. 
  • 4.5% incidence of arterial thromboembolism (CVA, MI, unstable angina, transient ischemic attack, claudication, subarachnoid haemorrhage and other arterial embolic events). Risk of cardiac failure with TKIs. 
  • Patients > 65 or with a previous history of arterial thromboembolic event at increased risk.  
  • Use of low dose aspirin (<325 mg/day) seems safe. Prophylactic aspirin (75-150mg) may be considered for those at high risk of thromboembolism provided there are no contra-indications to its usage.

Management of thromboembolism during course of treatment with VEGF-i

Venous thromboembolism (non-life threatening)  

  • Withhold VEGF-i for 2-3 weeks.  
  • If stable and no haemorrhagic complication then resume VEGF-i once stable on anticoagulant. 

Arterial thromboembolism or life-threatening venous thromboembolism 

  • Caution if previous history of arterial thromboembolic events especially if age over 65.  
  • Do not treat with a VEGF-i within at least 6 months of an arterial thromboembolic event (myocardial infarction, TIA, cerebrovascular accident or other event). VEGF-i should be started only if stable and asymptomatic from this event.  
  • Permanently stop VEGF-i if develop any arterial thromboembolic event during VEGF-i therapy.
  • Safe to treat with full-dose anticoagulant therapy – no apparent increased risk of bleeding.

Editorial Information

Last reviewed: 05/01/2024

Next review date: 05/01/2027

Author(s): Edinburgh Cancer Centre.

Version: 1.1

Approved By: Authorised by CTAC. Refer to Q-Pulse for approval details.

Reviewer name(s): Stewart J.