Anticoagulant Therapy In Cancer Patients Research Articles

Outcomes and Discriminatory Accuracy of the CHA2DS2VASc Score in Atrial Fibrillation and Cancer

BackgroundAtrial fibrillation (AF) is highly prevalent among cancer patients. The role of traditional risk stratification scores in the context of different cancer types in these patients remains unknown. ObjectivesThe purpose of this study was to determine the discriminative accuracy of the CHA2DS2VASc score for ischemic stroke using receiver operating characteristic and area under the curve. MethodsThe National Readmission Database (2015-2019) was used to identify all AF patients stratified by the cancer diagnosis, type, and CHA2DS2VASc category (low; moderate; high risk). Outcomes at 30-day readmission were compared between cancer and noncancer groups using hierarchical multivariable logistic regression to calculate adjusted odds ratios (aORs) and 95% CIs. ResultsA total of 6,996,088 AF patients were identified at index admission. Of these, 4,242,630 (642,237 cancer, 3,600,393 noncancer) were readmitted at 30 days. Cancer patients (92.1%) had a higher proportion of high CHA2DS2VASc scores compared with their noncancer counterparts (89.8%, P < 0.001). The 30-day readmission rate and incidence of major bleeding in cancer patients were significantly higher compared with their corresponding noncancer group across all CHA2DS2VASc categories. Among the different cancer types, hematological and lung cancer had a high propensity for major bleeding. The odds of ischemic stroke were lower in the cancer group across high (1.9% vs 2.4%; aOR: 0.78; 95% CI: 0.76-0.79; P < 0.0001), moderate (0.8% vs 1.3%; aOR: 0.57; 95% CI: 0.50-0.64; P < 0.0001), and low (0.4% vs 0.9%; aOR: 0.46; 95% CI: 0.34-0.62; P < 0.0001) risk category relative to the noncancer group irrespective of type of cancer. CHA2DS2VASc category had a statistically significant discriminatory accuracy for ischemic stroke in both cancer and noncancer patients. ConclusionsCancer patients with AF are at a higher risk of readmission and major bleeding. The risk of ischemic stroke during readmission appears to be lower than noncancer patients. These findings may have implications for anticoagulant therapy in cancer patients.

Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer.

In the general population, the incidence of thromboembolic events is 117 cases/100,000 inhabitants/year, while in cancer patient incidence, it is four-fold higher, especially in patients who receive chemotherapy and who are affected by pancreatic, lung or gastric cancer. At the basis of venous thromboembolism (VTE) there is the so-called Virchow triad, but tumor cells can activate coagulation pathway by various direct and indirect mechanisms, and chemotherapy can contribute to VTE onset. For these reasons, several studies were conducted in order to assess efficacy and safety of the use of anticoagulant therapy in cancer patients, both in prophylaxis setting and in therapy setting. With this review, we aim to record principal findings and current guidelines about thromboprophylaxis in cancer patients, with particular attention to subjects with additional risk factors such as patients receiving chemotherapy or undergoing surgery, hospitalized patients for acute medical intercurrent event and patients with central venous catheters. Nonetheless we added a brief insight about acute and maintenance therapy of manifested venous thromboembolism in cancer patients.

Clinical implications of incidental venous thromboembolism in cancer patients.

In cancer patients, current guidance suggests similar treatment for incidental and symptomatic venous thromboembolism (VTE), mainly based on retrospective data. We aimed to evaluate anticoagulant therapy in cancer patients with incidental and symptomatic VTE. The Hokusai VTE Cancer Study was a randomised controlled trial comparing edoxaban with dalteparin for cancer-associated VTE. The primary outcome was the composite of first recurrent VTE or major bleeding. Secondary outcomes included major bleeding, recurrent VTE and mortality. Outcomes in patients with incidental and symptomatic VTE were evaluated during the 12-month study period. 331 patients with incidental VTE and 679 patients with symptomatic VTE were enrolled, of whom the index event was confirmed by an independent radiologist. Median durations of anticoagulant treatment were 195 and 189 days, respectively. In patients with incidental VTE, the primary outcome occurred in 12.7% of patients, major bleeding in 6.6% of patients and recurrent VTE in 7.9% of patients. Out of the 26 VTE recurrences in patients with incidental VTE, five (31%) were incidental, seven (44%) were symptomatic and four (25%) were deaths for which pulmonary embolism could not be ruled out. In patients with symptomatic VTE, the primary outcome occurred in 13.8% of patients, major bleeding in 4.9% of patients and recurrent VTE in 10.9% of patients. All-cause mortality was similar in both groups. Clinical adverse outcomes are substantial in both cancer patients with incidental and symptomatic VTE, supporting current guideline recommendations that suggest treating incidental VTE in the same manner as symptomatic VTE.

Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism

BackgroundLow-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty. MethodsWe used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancer patients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study. ResultsAfter propensity matching, 482 cancer patients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20). ConclusionsIn cancer patients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH.

P-098: LMWH as drugs of choice as anticoagulant therapy in cancer patients

P-098: LMWH as drugs of choice as anticoagulant therapy in cancer patients

Outcome during and after anticoagulant therapy in cancer patients with incidentally found pulmonary embolism.

Current guidelines suggest treating cancer patients with incidental pulmonary embolism comparably to patients with symptomatic pulmonary embolism.We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry to compare the rate of major bleeding and symptomatic pulmonary embolism during the course of anticoagulation and after its discontinuation in cancer patients with incidental pulmonary embolism.As of March 2016, 715 cancer patients with incidental pulmonary embolism had been enrolled in RIETE. During the course of anticoagulant therapy (mean 235 days), the rate of major bleeding was higher than the rate of symptomatic pulmonary embolism (10.1 (95% CI 7.48-13.4) versus 3.17 (95% CI 1.80-5.19) events per 100 patient-years, respectively), and the rate of fatal bleeding was higher than the rate of fatal pulmonary embolism (2.66 (95% CI 1.44-4.52) versus 0.66 (95% CI 0.17-1.81) deaths per 100 patient-years, respectively). After discontinuing anticoagulation (mean follow-up 117 days), the rate of major bleeding was lower than the rate of symptomatic pulmonary embolism (3.00 (95% CI 1.10-6.65) versus 8.37 (95% CI 4.76-13.7) events per 100 patient-years, respectively); however, there were no differences in the rate of fatal events at one death each.The risk/benefit ratio of anticoagulant therapy in cancer patients with incidental pulmonary embolism is uncertain and must be evaluated in further studies.

PO-37 - Optimization of the anticoagulant therapy in cancer patients

Thrombophilia is a serious risk factor for cancer patients. To determine the optimal mode of appointment of antithrombotic prophylaxis in perioperative period in cancer patients. The study involved 889 patients with gynecological cancer in the perioperative period. Group I - LMWH for 10days before surgery 0.3ml, cessation of therapy 24hours before surgery, then 0.3ml for 10days postoperatively - 213 patients Group II - LMWH 24hours before surgery, then 0.3ml for 10days in postoperative period - 212 Group III - LMWH 0.3ml for 10days postoperatively - 216 Group IV - unfractionated heparin 5000IU 3 times a day for 10days in the postoperative period - 248. Before surgery rate of subcompensated DIC was 18.5-50%. After surgery rate of subcompensated DIC has increased significantly to 52-75%. In group I, normal levels of DIC markers (TAT, PF4, F1+2) has been observed in 1-3 days. In group II normalization of DIC markers has been observed in 3-5 days. In group III DIC markers tended to normalize in 5-7 days. In group IV normalization of DIC markers has been detected only on the 7th day. D-dimer in some patients remained heightened for up to 10days. In addition, 28 patients (13.7%) formed extensive bruising in the painful injection. The proposed scheme prophylaxis: LMWH 10days before surgery and cancel 24hours prior to surgery, then 0.3ml for 10days in the postoperative period - virtually eliminates the risk of thrombosis and contributes normalization of DIC markers in 3days. This scheme could be recommended for all cancer patients as a minimum program.

Edoxaban For Long-Term Treatment Of Venous Thromboembolism In Cancer Patients

▪Low-molecular-weight heparin (LMWH) is recommended for long-term anticoagulant therapy in cancer patients with venous thromboembolism (VTE). These patients have been mostly excluded from clinical trials comparing new oral anticoagulants with vitamin-K antagonists. Hokusai-VTE was a global randomized, double-blind, non-inferiority trial (margin 1.5) that compared edoxaban, an oral factor Xa inhibitor, with warfarin for long-term therapy in 8,292 patients with acute symptomatic proximal deep-vein thrombosis and/or pulmonary embolism; all patients received initial LMWH treatment for at least 5 days. Patients with active cancer in whom long-term treatment with LMWH was anticipated were excluded, but patients with a history of cancer or with active cancer were eligible if long-term LMWH treatment was not planned due to availability, physician judgment or patient preference; the analysis of outcomes in these patients was pre-specified before the trial. The edoxaban dose was 60 mg once daily (30 mg in patients with body weight less than 60 kg or creatinine clearance 30 to 50 ml/min). Warfarin was adjusted to maintain the INR between 2.0 and 3.0. The primary efficacy outcome was recurrent symptomatic VTE. The efficacy analysis included all patients who received at least one dose of study drug, and included all outcomes through 12 months follow-up or study closure, regardless of the duration of treatment. The principal safety outcome was major or clinically relevant non-major bleeding, occurring on treatment or within 3 days of stopping treatment. All outcomes were adjudicated by an independent committee blinded to treatment allocation. A total of 771 cancer patients (9.3%) were enrolled (208 with active cancer and 563 with a history of cancer).The baseline clinical characteristics of patients in the edoxaban and warfarin groups were similar. The median duration of treatment in the edoxaban group was 267 days and in the warfarin group was 266 days (interquartile range 180 to 360 days in both groups). Among patients with active cancer, recurrent VTE occurred in 4 of 109 patients (3.7%) who received edoxaban and in 7 of 99 patients (7.1%) who received warfarin (hazard ratio 0.55, 95% CI 0.16 to 1.85). Clinically relevant bleeding (major or non-major) occurred in 20 patients (18.3%) given edoxaban (5 patients with major, 4.6%) and 25 patients (25.3%) given warfarin (3 patients with major, 3.0%) (hazard ratio for clinically relevant bleeding 0.72, 95% CI 0.40 to 1.30). Among all 771 cancer patients at entry, recurrent VTE occurred in 14 of 378 patients (3.7%) given edoxaban and in 28 of 393 patients (7.1%) who received warfarin (hazard ratio 0.53, 95% CI 0.28 to 1.00). Clinically relevant bleeding (major or non-major) occurred in 47 patients (12.4%) given edoxaban (10 patients with major, 2.6%) and 74 patients (18.8%) given warfarin (13 patients with major, 3.3%) (hazard ratio for clinically relevant bleeding 0.64, 95% CI 0.45 to 0.92). Among patients without cancer, either at entry or occurring during follow-up, recurrent VTE occurred in 103 of 3,658 patients (2.8%) given edoxaban and in 99 of 3,629 (2.7%) who received warfarin (hazard ratio 1.03, 95% CI 0.78 to 1.36, p=0.004 for non-inferiority). Clinically relevant bleeding (major or non-major) occurred in 280 of 3658 patients (7.7%) who received edoxaban (39 patients with major, 1.1%) and in 330 of 3629 patients (9.1%) given warfarin (48 patients with major, 1.3%) (hazard ratio for clinically relevant bleeding 0.83, 95% CI 0.71 to 0.97, p=0.022). The results suggest edoxaban is as effective, and possibly more effective, than warfarin in cancer patients with VTE. In such patients, bleeding is appreciable during anticoagulant therapy, and may potentially be reduced by edoxaban therapy. Additional studies of edoxaban for initial and long-term therapy of VTE in cancer patients are indicated, with LMWH as the comparator, and including lower doses of edoxaban to determine if bleeding can be further reduced without loss of efficacy. Disclosures:Raskob: Daiichi-Sankyo Pharma: Consultancy; Bayer Healthcare: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Johnson and Johnson: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi-Aventis: Consultancy; Quintiles: Consultancy; Portola: Consultancy; Takeda: Consultancy. Off Label Use: presentation of subgroup analysis from phase III clinical trial. Buller:Daiichi Sankyo : Consultancy, Membership on an entity's Board of Directors or advisory committees; Bayer Healthcare: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Boehringer Ingelheim: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees; Isis Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; ThromboGenics: Honoraria, Membership on an entity's Board of Directors or advisory committees. Angchaisuksiri:Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees, Research Funding. Oh:Daiichi Sankyo : Membership on an entity's Board of Directors or advisory committees, Research Funding. Boda:Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees, Research Funding. Lyons:Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Lilly: Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding. Weitz:Daiichi Sankyo: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Boehringer Ingelheim: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Bayer Healthcare: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen : Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Portola: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Zhang:Daiichi Sankyo: Employment. Lanz:Daiichi Sankyo: Employment. Mercuri:Daiichi Sankyo: Employment.

Platelet Cut-Off For Anticoagulant Therapy In Cancer Patients With Venous Thromboembolism and Thrombocytopenia: An Expert Opinion Based On RAND/UCLA Appropriateness Method (RAM)

▪ IntroductionCancer-related Venous Thromboembolism (VTE) requires treatment with Low Molecular Weight Heparin (LMWH), which is more effective and safer than warfarin; however, the risk of major hemorrhage still remains clinically relevant (up to 5%). This rate is even higher in case of impaired hemostasis, such as during thrombocytopenia (due to myelosuppression or chemo-therapy) where the bleeding risk is directly related to the platelet count level. At the present, the best management of adult patients with acute or non-acute cancer-related VTE during thrombocytopenia is uncertain. ObjectiveTo develop a consensus about the platelet cut-off for a safe LMWH administration in cancer patients with acute (lasting < 1 month) or non-acute VTE and thrombocytopenia, based on RAND/UCLA Appropriateness Method (RAM). Materials and methodsA systematic review of the literature was performed via electronic databases (MEDLINE, EMBASE, and Cochrane Library Central Registry). Topics and research terms were: cancer, venous thromboembolism, platelets, risk of bleeding, anticoagulant drugs, low-molecular-weight heparin, and treatments. The main study outcomes were rates of VTE (first event, recurrence, and catheter-related DVT), major and minor bleeding, thrombocytopenia, and death. A panel of experts was identified; the literature review and the list of indications were sent to all members of this panel. For each indication, the panel members rated the benefit-to-harm ratio of the procedure on a scale of 1 to 9, where 1 means that the expected harms greatly outweigh the expected benefits, and 9 means that the expected benefits greatly outweigh the expected harms. A middle rating of 5 means either that the harms and benefits are about equal or that the rater cannot make the judge for the patient described in the indication. The working group comprised 9 hematologists expert in thrombosis and haemostasis (G.S., M.M., M.C., V.D.S., A.F., A.F., F.R., A.T., S.S.) including two methodologists (G.S. and M.M.) and one coordinator (S.S.). Consensus Developmentthe RAND was construed identifying 3 platelet count cut-offs (i.e., PLT >50.000 <100.000 µL; PLT >30.000 <50.000 µL; PLT <30.000 µL) and 3 doses of LMWH (weight adjusted fixed-dose, prophylactic dose, and half of the weight adjusted fixed-dose) by administering 13 questions to the experts. ResultsThe panel of expert reached the following consensus: 1. Cancer patients with acute VTE and a platelet count <100.000 µL - >50.000 should receive full therapeutic dose LMWH ; 2. In cases of non-acute VTE with platelet count <100.000 µL - >50.000, the dose of LMWH should be reduced to 75% of the full dose; 3. In cancer patients with acute VTE and platelet count <50.000 - >30.000 µL, the LMWH dose should be reduced to 50% of the full therapeutic dose; 4. In case of non-acute VTE and a platelet count <50.000 µL - >30.000, the expert panel considers uncertain a treatment with a reduced dose to 50% or a low dose (i.e. 4.000 IU anti-FXa/d); 5. In case of platelet count below 30.000 µL, the expert panel agreed to suspend LMWH both in acute and non-acute VTE. ConclusionsThis is the first expert opinion based on RAM to establish the safe platelet cut-off to administer LMWH therapy in cancer patients affected by acute and non-acute VTE. The present panel of experts suggests as appropriate the use of dose-adjusted LMWH according to platelets count. Further investigations by means of well designed prospective clinical trials are needed to establish the best management of cancer-related VTE in patients with thrombocytopenia. Disclosures:Rodeghiero:Amgen, GSK: Honoraria; Amgen, Eisai, GSK, LFB, Suppremol: Membership on an entity's Board of Directors or advisory committees.

Fertility rates and gross national incomes per capita

Current guidelines suggest treating cancer patients with incidental pulmonary embolism comparably to patients with symptomatic pulmonary embolism. We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry to compare the rate of major bleeding and symptomatic pulmonary embolism during the course of anticoagulation and after its discontinuation in cancer patients with incidental pulmonary embolism. As of March 2016, 715 cancer patients with incidental pulmonary embolism had been enrolled in RIETE. During the course of anticoagulant therapy (mean 235 days), the rate of major bleeding was higher than the&nbsp;rate of symptomatic pulmonary embolism (10.1 (95% CI 7.48–13.4) <i>versus</i> 3.17 (95% CI 1.80–5.19) events per 100 patient–years, respectively), and the rate of fatal bleeding was higher than the rate of fatal pulmonary embolism (2.66 (95% CI 1.44–4.52) <i>versus</i> 0.66 (95% CI 0.17–1.81) deaths per 100 patient-years, respectively). After discontinuing anticoagulation (mean follow-up 117 days), the rate of major bleeding was lower than the rate of symptomatic pulmonary embolism (3.00 (95% CI 1.10–6.65) <i>versus</i> 8.37 (95% CI 4.76–13.7) events per 100 patient-years, respectively); however, there were no differences in the rate of fatal events at one death each. The risk/benefit ratio of anticoagulant therapy in cancer patients with incidental pulmonary embolism is uncertain and must be evaluated in further studies.

Treatment of venous thromboembolism in cancer patients.

The occurrence of venous thromboembolism complicates the management of the patient with malignant disease because of the need for anticoagulant therapy. Cancer patients have an ongoing thrombotic stimulus due to the underlying cancer and its associated treatments, but are also considered to be at increased risk for anticoagulant-related bleeding. In recent years, the results of clinical trials have demonstrated the safety and efficacy of weight-adjusted subcutaneous low molecular weight heparin, administered at home, for patients with acute deep vein thrombosis. This approach is particularly attractive to patients with cancer where quality of life is an important consideration. There are no trials that specifically address the question of the duration of oral anticoagulant therapy in cancer patients. However, data can be extrapolated from trials evaluating the duration of oral anticoagulant therapy in other high-risk patients. Hence, cancer patients should continue oral anticoagulant therapy for as long as the cancer remains active (usually at least 6 months). There still remain a number of unanswered questions about the clinical management of thromboembolism in the cancer patient.

Treatment of Venous Thromboembolism in Cancer Patients

The occurrence of venous thromboembolism complicates the management of the patient with malignant disease because of the need for anticoagulant therapy. Cancer patients have an ongoing thrombotic stimulus due to the underlying cancer and its associated treatments, but are also considered to be at increased risk for anticoagulant-related bleeding. In recent years, the results of clinical trials have demonstrated the safety and efficacy of bodyweight-adjusted subcutaneous low-molecular-weight heparin administered at home for patients with acute deep vein thrombosis. This approach is particularly attractive in patients with cancer, in whom quality of life is an important consideration. There are no trials to date which specifically address the question of the duration of oral anticoagulant therapy in cancer patients. However, data can be extrapolated from trials evaluating the duration of oral anticoagulant therapy in other high-risk patients. Hence, cancer patients should continue oral anticoagulant therapy for as long the cancer remains active (usually at least 6 months). There remain a number of unanswered questions regarding the clinical management of thromboembolism in the cancer patient.

Traitement de la maladie thromboembolique veineuse (MTE) chez les patients cancéreux

Results of classical anticoagulant therapy in cancer patients with venous thromboembolism (VT) are highly discussed. We retrospectively analysed the outcome of 43 patients with VT and cancer: 32% developed specific complications during either i.v. heparin therapy (10 +/- 0.9 days) or treatment by antivitamin K (106 +/- 14.9 days). Recurrence of thromboembolism (16%) and/or hemorrhages (16%) were much more frequent than in patients without cancer, underlying need for alternative therapy in cancer patients with VT.

Hemorrhagic and Thrombotic Abnormalities of Cancer

Cancer patients are at risk for profound derangements in the hemostatic mechanism due to multiple factors. Depending upon the dominant abnormality, bleeding, thrombosis or both, in conjunction with disseminated intravascular coagulation, may occur. Critical care physicians should have a high index of suspicion for underlying hemostatitic defects when a cancer patient presents with hemorrhage. Blood replacement therapy tailored to specific abnormalities coupled with effective treatment of the underlying malignancy will render the best result. Thrombosis in malignancy is a frequent occurrence and increasing in incidence due in part to the widespread use of indwelling venous catheters. Fibrinolytic therapy is effective and probably under-utilized in treating thrombosis but must be approached with care in these patients. A thorough understanding of diagnostic techniques, indications, and potential complications of anticoagulant therapy in cancer patients is essential.