Treatment of cancer-associated thrombosis: The evolution of anticoagulant choice and clinical insights into practical management.

Hanno Riess, Peter Verhamme, Jeffrey I Weitz, Annie Young, Rupert Bauersachs, Jan Beyer-Westendorf, Mark Crowther, Anthony Maraveyas

Journal: Critical reviews in oncology/hematology 2021;157():103125

PMID: 33254037

Full Text on Elsevier Science View on PubMed

Abstract

Low-molecular-weight heparin (LMWH) therapy is recommended over vitamin K antagonists (VKAs) for the treatment of cancer-associated thrombosis (CAT) and extended therapy is recommended in those with active cancer to prevent recurrent thrombosis. However, the inconvenience of daily subcutaneous injections and the cost of LMWH therapy hinder long-term use. Observational data demonstrate that persistence with LMWH therapy is low in clinical practice and that many patients are switched to oral alternatives - namely VKAs and direct oral anticoagulants (DOACs). Recently, the efficacy and safety of apixaban, edoxaban, and rivaroxaban versus LMWH therapy for the treatment of CAT have been demonstrated in randomized trials. This review provides a critical evaluation of studies with DOACs in this setting and an update on the guidance regarding anticoagulant use for the treatment of CAT. In recognition of the heterogeneity of patients with cancer and the challenges of CAT, patient cases with expert clinical perspectives are presented.

Address: Department of Haematology and Oncology, Charite - Universitatmedizin Berlin, Germany. Electronic address: [email protected].; Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium.; McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada.; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.; Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany.; Thrombosis Research Unit, Department of Medicine I, Division Hematology, University Hospital "Carl Gustav Carus" Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany; King's Thrombosis Service, Department of Haematology, King's College London, London, United Kingdom.; Hull York Medical School and Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom.

DOI: 10.1016/j.critrevonc.2020.103125