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Direct oral anticoagulants for treatment and prevention of venous thromboembolism in cancer patients

Authors Song AB, Rosovsky RP, Connors JM, Al-Samkari H

Received 18 February 2019

Accepted for publication 5 May 2019

Published 21 June 2019 Volume 2019:15 Pages 175—186

DOI https://doi.org/10.2147/VHRM.S132556

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Magnus Bäck


Andrew B Song,1 Rachel P Rosovsky,1 Jean M Connors,2 Hanny Al-Samkari1

1Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2Division of Hematology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Abstract: Venous thromboembolism (VTE) is a common cause of morbidity and mortality in patients with cancer. Compared with the general population, cancer patients with VTE have higher rates of both VTE recurrence and bleeding. While low molecular weight heparin (LMWH) has been the mainstay of treatment for cancer-associated VTE for over a decade, direct oral anticoagulants (DOACs) have recently emerged as a new therapeutic option due to their ease of administration and because they do not require laboratory monitoring. Several large randomized clinical trials have been performed or are ongoing at the time of writing, comparing DOACs with LMWH in this population. Three of these trials have thus far been published and suggest that DOACs are a reasonable alternative to LMWH for management of cancer-associated VTE. Despite the advantages offered by DOACs, these agents may not be appropriate for certain patient groups owing to increased risk of bleeding, organ compromise, extremes of weight, and other issues. Finally, data are emerging suggesting that DOACs may be useful for primary thromboprophylaxis in cancer patients in conjunction with validated risk assessment scores. In this evidence-based review, data for the use of DOACs to treat cancer-associated VTE will be examined, focusing on efficacy, safety, and timing of treatment. Guidance on choosing the optimal anticoagulant for a given patient is also offered.

Keywords: venous thromboembolism, malignancy, thrombosis, rivaroxaban, apixaban, edoxaban, DOAC

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