J Korean Med Sci.  2019 Feb;34(6):e52. 10.3346/jkms.2019.34.e52.

Current Management of Cancer-associated Venous Thromboembolism: Focus on Direct Oral Anticoagulants

• Kim SA
• Yhim HY
• Bang SM

• KMID: 2437951
• DOI: http://doi.org/10.3346/jkms.2019.34.e52

Abstract

Cancer-associated venous thromboembolism (CAT) is a common complication associated with high morbidity and mortality. In accordance with major clinical trials comparing low-molecular-weight heparin (LMWH) with a vitamin K antagonist (VKA), LMWH is currently the standard treatment for CAT, owing to its efficacy for thrombosis recurrence and improved safety profile compared to VKA. Over the past few years, direct oral anticoagulants (DOACs) have emerged as potential alternative therapies to LMWH due to their convenient route of administration and predictable pharmacokinetics, but evidence for their use in CAT is inconclusive, as only a small fraction of the study populations in these trials had CAT. Recently, two large head-to-head trials comparing DOACs to LMWH in CAT patients reported comparable efficacies of DOACs with increased bleeding risk. Occasionally, CAT treatment can be challenging due to the heterogeneity of underlying malignancies and comorbidities. Renal insufficiency and gastrointestinal defects are the main obstacles in anticoagulant selection. Careful choice of treatment candidates and proper anticoagulant strategies are critical for the treatment of CAT; hence, more studies are required to address these challenges.

Keyword

Cancer-associated Venous Thromboembolism; Low-Molecular-Weight Heparin; Direct Oral Anticoagulants

MeSH Terms

Animals
Anticoagulants*
Cats
Comorbidity
Complementary Therapies
Hemorrhage
Heparin, Low-Molecular-Weight
Humans
Mortality
Pharmacokinetics
Population Characteristics
Recurrence
Renal Insufficiency
Thrombosis
Venous Thromboembolism*
Vitamin K
Anticoagulants
Heparin, Low-Molecular-Weight
Vitamin K