To Use or not to Use Anticoagulation in Patients with Advanced Malignancies? – This is the Question

Abstract

The management of cancer-associated thrombosis (CAT) often presents challenges to members of medical teams, attending to patients with advanced malignancies. In general, indications for treatment of CAT have been driven by the randomized clinical trials (RCTs) that have usually excluded patient populations suffering from metastatic cancers, at the end-of-life period. Since the findings of such RCTs are not representative of this particular group of oncology patients, medical providers need practical help in the daily care of this population. It should be noted that venous thromboembolism (VTE) associated with cancer has been related to increased morbidity and mortality rates, as well as different symptoms that can deteriorate the patient’s quality of life (QoL). Therefore, current guidelines promote the use of anticoagulation therapy in oncology patients, focusing on the acute care contexts (e.g., a perioperative period, or chemotherapy (CHT) regimen). In contrast, in the palliative care (PC) setting, the main benefit of anticoagulation should be a reduction of symptom burden associated with VTE. However, during end-of-life care, the risk of bleeding can often overweight the potential benefits of anticoagulation. To shed some light on these complicated issues, this mini-review presents some challenges in CAT anticoagulation management. It briefly discusses VTE risk factors and therapeutic options and compares acute and PC services. This overview supports therapeutic teams in charge of oncology patients receiving PC services, where the main goal is not life extension but an assurance of the best possible QoL.