{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T09:04:47Z","timestamp":1777712687326,"version":"3.51.4"},"reference-count":78,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Venous thromboembolism (VTE) is a frequent complication in patients with cancer, especially those receiving systemic therapy in the ambulatory setting. Despite being a largely preventable condition, it remains a leading cause of morbidity and mortality in this patient population. Risk prediction models, such as the Khorana score, have been developed to stratify patients according to their underlying risk of VTE and identify those most likely to benefit from thromboprophylaxis by improving its risk-benefit ratio. Recent evidence supports the efficacy and safety of both low molecular weight heparin and direct oral anticoagulants in reducing VTE incidence in ambulatory patients with cancer who are receiving systemic therapy and are at high risk of VTE. Nevertheless, despite guideline recommendations warranting a risk-based approach, studies persistently show low adoption of thromboprophylaxis in this patient population. Barriers to implementation are complex, including clinician-, patient- and system-related factors. However, promising implementation strategies, including electronic health record integrated risk calculators, structured education programs, and patient-centered care pathways, have shown potential in improving adherence to guidelines and better clinical outcomes. This review summarizes the current evidence for thromboprophylaxis in patients with cancer, explores the challenges in translating evidence into practice, and highlights successful models designed to close the gap between guidelines and clinical practice.<\/jats:p>","DOI":"10.1182\/hematology.2025000689","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T14:10:51Z","timestamp":1764943851000},"page":"72-79","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":2,"title":["Implementation failure: thromboprophylaxis in ambulatory patients with cancer"],"prefix":"10.1182","volume":"2025","author":[{"given":"Elena","family":"Butera","sequence":"first","affiliation":[{"name":"1 Thrombosis Unit, Department of Aging, Orthopedic, and Rheumatologic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"},{"name":"2 Department of Medicine, University of Ottawa at the Ottawa Hospital and the Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzu-Fei","family":"Wang","sequence":"additional","affiliation":[{"name":"2 Department of Medicine, University of Ottawa at the Ottawa Hospital and the Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Pola","sequence":"additional","affiliation":[{"name":"1 Thrombosis Unit, Department of Aging, Orthopedic, and Rheumatologic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Carrier","sequence":"additional","affiliation":[{"name":"2 Department of Medicine, University of Ottawa at the Ottawa Hospital and the Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"234","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"2025120616354918500_hem2025000689C1","first-page":"188","article-title":"De l'Obliteration des veines et de son influence sur la formation des hydropisies partielles: consideration sur la hydropisies passive et general","volume":"1","author":"Bouillard","year":"1823","journal-title":"Arch Gen Med"},{"issue":"14","key":"2025120616354918500_hem2025000689C2","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1182\/blood.2020007338","article-title":"Venous thromboembolism in cancer patients: a population-based cohort study","volume":"137","author":"Mulder","year":"2021","journal-title":"Blood"},{"issue":"3","key":"2025120616354918500_hem2025000689C3","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/j.1538-7836.2007.02374.x","article-title":"Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy","volume":"5","author":"Khorana","year":"2007","journal-title":"J Thromb Haemost"},{"issue":"21","key":"2025120616354918500_hem2025000689C4","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1182\/blood.V118.21.674.674","article-title":"Higher incidence of venous thromboembolism in the outpatient versus the inpatient setting among U.S. cancer patients","volume":"118","author":"Khorana","year":"2011","journal-title":"Blood"},{"issue":"5","key":"2025120616354918500_hem2025000689C5","doi-asserted-by":"crossref","DOI":"10.1016\/j.rpth.2024.102510","article-title":"Quality of life in oncological patients with venous thromboembolic disease","volume":"8","author":"Arteaga","year":"2024","journal-title":"Res Pract Thromb Haemost"},{"issue":"6","key":"2025120616354918500_hem2025000689C6","doi-asserted-by":"crossref","first-page":"469","DOI":"10.2146\/ajhp110187","article-title":"Preventing venous thromboembolism in hospitalized patients with cancer: improving compliance with clinical practice guidelines","volume":"69","author":"Brown","year":"2012","journal-title":"Am J Health Syst Pharm"},{"issue":"2","key":"2025120616354918500_hem2025000689C7","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1160\/TH16-08-0615","article-title":"Cancer-associated venous thromboembolism: burden, mechanisms, and management","volume":"117","author":"Ay","year":"2017","journal-title":"Thromb Haemost"},{"issue":"6","key":"2025120616354918500_hem2025000689C8","doi-asserted-by":"crossref","DOI":"10.1136\/esmoopen-2020-000948","article-title":"Prevention of venous thromboembolism in ambulatory patients with cancer","volume":"5","author":"Khorana","year":"2020","journal-title":"ESMO Open"},{"key":"2025120616354918500_hem2025000689C9","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/S1470-2045(09)70232-3","article-title":"Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study","volume":"10","author":"Agnelli","year":"2009","journal-title":"Lancet Oncol"},{"issue":"7","key":"2025120616354918500_hem2025000689C10","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1056\/NEJMoa1108898","article-title":"Semuloparin for thromboprophylaxis in patients receiving chemotherapy for cancer; 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