Abstract
Cancer is a hypercoagulable state with an associated increased risk of venous thromboembolism (vte) that is further amplified in individuals who undergo chemotherapy. Compared with patients having cancer alone or vte alone, patients who develop cancer-associated vte have a significantly poorer prognosis. The risks of recurrent vte despite appropriate anticoagulation therapy and of bleeding are also higher in patients with cancer than in those without. For those reasons, the prevention and appropriate management of cancer-associated thrombosis is of paramount importance. Although low-molecular-weight heparin has been the standard of care for the prevention and treatment of cancer-associated thrombosis, direct oral anticoagulants are increasingly being adopted as an effective and safe alternative.
Highlights
Cancer-associated thrombosis is a major cause of morbidity and mortality in patients with malignancy
Aside from individual patient-related risk factors, tumour-related risk factors such as tumour type, tumour stage and grade, and the anticancer treatments being delivered contribute to heightened vte risk[7]
Low-molecular-weight heparin has been the mainstay of treatment for acute cancer-associated vte for many years, given that several studies showed it to be associated with a lower risk of vte recurrence without a significant increase in major bleeding in a comparison with vitamin K antagonists[17]
Summary
Cancer-associated thrombosis is a major cause of morbidity and mortality in patients with malignancy. The risks of recurrent vte despite appropriate anticoagulation therapy and of bleeding are higher for patients with cancer than for those without[4]. Low-molecular-weight heparin (lmwh) has been the standard of care for the prevention and treatment of cancer-associated vte for many years, direct oral anticoagulants (doacs) are increasingly being used after several landmark trials showed them to be effective and safe options.
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