Anticoagulation of cancer patients with non‐valvular atrial fibrillation receiving chemotherapy: Guidance from the SSC of the ISTH

Delluc, Aurélien; Wang, Tzu‐Fei; Yap, Eng Soo; Ay, Cihan; Schaefer, Jordan K.; Carrier, Marc; Noble, Simon

doi:10.1111/jth.14478

Cited by 65 publications

(40 citation statements)

References 46 publications

(45 reference statements)

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“…With these caveats, data with DOAC reveal a generally favorable safety picture. In line with results obtained in the general population, edoxaban and rivaroxaban seem to increase gastrointestinal bleeding [9,25,28,76,79,80], while apixaban does not [76,78,81]. There is less data of patients with active cancer treated with dabigatran, although a large study reported similar results than with rivaroxaban [76].…”

Section: What Is the Ideal Anticoagulant Agent For Patients With Cancsupporting

confidence: 63%

“…While the specific results will vary based on the population included, it is likely that the net benefit of anticoagulation is dynamic in most populations with active cancer and careful and periodic assessment of patient-and cancer-related factors have to be regarded. A relevant consideration, perceptively pointed out by Delluc et al [28], is that before recommending against anticoagulation because of high bleeding risk under specific therapies, one should consider whether the benefits of anticoagulation could be greater than those of such anti-neoplastic therapies. They offer the example of adjuvant chemotherapy as the time when this question can most often come up.…”

Section: What Patients With Af and Active Cancer Should Receive Anticmentioning

confidence: 99%

“…Nevertheless, in the last few months, several authors and societies have offered guidance for these patients and their physicians. Table 1 [14,[26][27][28][29][30][31][32][33][34] outlines them.…”

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confidence: 99%

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Oral anticoagulation in patients with active cancer and atrial fibrillation: current challenges

Sorigué

2020

Polish Archives of Internal Medicine

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.

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Section: What Is the Ideal Anticoagulant Agent For Patients With Cancsupporting

confidence: 63%

Section: What Patients With Af and Active Cancer Should Receive Anticmentioning

confidence: 99%

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Oral anticoagulation in patients with active cancer and atrial fibrillation: current challenges

Sorigué

2020

Polish Archives of Internal Medicine

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“…A large Danish nationwide cohort study demonstrated that the absolute risks of thromboembolic and bleeding complications were similar in patients with AF with and without cancer, irrespective of VKA or DOAC prescription . Guidance from the Scientific and Standardization Committee of the ISTH on anticoagulation of patients with cancer with nonvalvular AF receiving chemotherapy has recently been published …”

Section: Rationale For Studying the Use Of Doacs For Catmentioning

confidence: 99%

“…However, patients with cancer in the palliative care setting are underrepresented in these clinical trials. Recent data from a multicenter observational study (N = 1199) found a low incidence of VTE (0.5% symptomatic DVT) but a high incidence (9.8%) of clinically relevant bleeding associated with thromboprophylaxis, suggesting that the bleeding risk of VTE prophylaxis might outweigh the benefits in this population …”

Section: Current Controversies In Catmentioning

confidence: 99%

Cancer‐associated venous thromboembolism: Treatment and prevention with rivaroxaban

Bauersachs¹,

Khorana

Lee

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Cancer‐associated venous thromboembolism (VTE) is a frequent, potentially life‐threatening event that complicates cancer management. Anticoagulants are the cornerstone of therapy for the treatment and prevention of cancer‐associated thrombosis (CAT); factor Xa–inhibiting direct oral anticoagulants (DOACs; apixaban, edoxaban, and rivaroxaban), which have long been recommended for the treatment of VTE in patients without cancer, have been investigated in this setting. The first randomized comparisons of DOACs against low‐molecular‐weight heparin for the treatment of CAT indicated that DOACs are efficacious in this setting, with findings reflected in recent updates to published guidance on CAT treatment. However, the higher risk of bleeding events (particularly in the gastrointestinal tract) with DOACs highlights the need for appropriate patient selection. Further insights will be gained from additional studies that are ongoing or awaiting publication. The efficacy and safety of DOAC thromboprophylaxis in ambulatory patients with cancer at a high risk of VTE have also been assessed in placebo‐controlled randomized controlled trials of apixaban and rivaroxaban. Both studies showed efficacy benefits with DOACs, but both studies also showed a nonsignificant increase in major bleeding events while on treatment. This review summarizes the evidence base for rivaroxaban use in CAT, the patient profile potentially most suited to DOAC use, and ongoing controversies under investigation. We also describe ongoing studies from the CALLISTO (Cancer Associated thrombosis—expLoring soLutions for patients through Treatment and Prevention with RivarOxaban) program, which comprises several randomized clinical trials and real‐world evidence studies, including investigator‐initiated research.

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Hemorrhage Risk Among Patients With Breast Cancer Receiving Concurrent Direct Oral Anticoagulants With Tamoxifen vs Aromatase Inhibitors

et al. 2022

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IMPORTANCE Tamoxifen is commonly used as adjuvant therapy in breast cancer and is proposed to interfere with cytochrome P450 enzyme and P-glycoprotein pathways. Concurrent use with direct oral anticoagulants (DOACs) poses the threat of a potentially dangerous drug-drug interaction by leading to an increase in hemorrhage risk. OBJECTIVE To assess the risk of hemorrhage in patients with breast cancer coprescribed a DOAC and tamoxifen compared with a DOAC and an aromatase inhibitor (AI). DESIGN, SETTING, AND PARTICIPANTSThis population-based, retrospective cohort study was conducted among adults aged 66 years or older who were prescribed tamoxifen (compared with an

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Anticoagulation of cancer patients with non‐valvular atrial fibrillation receiving chemotherapy: Guidance from the SSC of the ISTH

Cited by 65 publications

References 46 publications

Oral anticoagulation in patients with active cancer and atrial fibrillation: current challenges

Oral anticoagulation in patients with active cancer and atrial fibrillation: current challenges

Cancer‐associated venous thromboembolism: Treatment and prevention with rivaroxaban

Hemorrhage Risk Among Patients With Breast Cancer Receiving Concurrent Direct Oral Anticoagulants With Tamoxifen vs Aromatase Inhibitors

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