Abstract
Venous thromboembolism (VTE) complicates the clinical course of approximately 5–10% of all cancer patients. Anticoagulation of the cancer patient often presents unique challenges as these patients have both a higher risk of recurrent VTE and a higher risk of bleeding than patients without cancer. Although low molecular weight heparins (LMWH) are the standard of care for the management of cancer-associated VTE, their use requires once or twice daily subcutaneous injections, which can be a significant burden for many cancer patients who often require a long duration of anticoagulation. The direct oral anticoagulants (DOACs) are attractive options for patients with malignancy. DOACs offer immediate onset of action and short half-lives, properties similar to LMWH, but the oral route of administration is a significant advantage. Given the higher risks of recurrent VTE and bleeding, there has been concern about the efficacy and safety of DOACs in this patient population. Data are now emerging for the use of DOACs in the cancer patient population from dedicated clinical trials. While recently published data suggest that DOACs hold promise for the treatment of cancer associated VTE, additional studies are needed to establish DOACs as the standard-of-care treatment. Many such studies are currently underway. The available data for the use of DOACs in the treatment of cancer-associated VTE will be reviewed, focusing on efficacy, safety, and other considerations relevant to the cancer patient.
Highlights
Malignancy is a known risk factor for venous and arterial thrombosis
We explore the challenges of anticoagulation in the cancer population, the options for treating these patients, and offer evidence-based recommendations regarding the use of direct oral anticoagulants (DOACs) in the cancer patient
To be 3.3, 7.9, and 7.9 months, respectively [27]. Another large database analysis of 964 cancer patients found that rates of recurrent Venous thromboembolism (VTE), major bleeding, and non-major bleeding were similar in patients receiving indefinite low molecular weight heparin (LMWH) to those completing 6 months of LMWH who were transitioned to warfarin by providers [29]
Summary
Venous thromboembolism (VTE) occurs in approximately 5–10% of cancer patients, a 4 to 7-fold increased risk over patients without cancer [1]. While standard-of-care management of cancer-associated VTE for over a decade has been therapeutic anticoagulation with low molecular weight heparin (LMWH) [6], this field is rapidly evolving, with recent evidence suggesting non-inferiority of oral direct factor Xa inhibitors to prevent cancer-associated VTE recurrence [7,8]. While direct oral anticoagulants (DOACs) are an attractive option given their oral bioavailability, a critical analysis suggests that they may not be optimal in several cancer patient populations. We explore the challenges of anticoagulation in the cancer population, the options for treating these patients, and offer evidence-based recommendations regarding the use of DOACs in the cancer patient
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call