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If no dietary or lifestyle changes are made, energy levels may dip slightly, especially in B12-deficient individuals

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additional injections of vitamin B12 on the same day as pemetrexed or pralatrexate treatments as needed

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and markers of thrombosis and endothelial cell activation including plasminogen activator inhibitor-1 (PAI-1), protein C, protein S, Von Willebrand factor (vWF), factor IX, intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion protein 1 (VCAM-1) (Fig