Are Patients with Active Cancer and Those with History of Cancer Carrying the Same Risks of Recurrent VTE and Bleeding While on Anticoagulants?

Abstract

Direct oral anticoagulants (DOAC) are now recommended for the treatment of cancer-associated thrombosis (CAT) based on the results of dedicated trials demonstrating that DOAC are non-inferior to low molecular weight heparins in preventing recurrent venous thromboembolism (VTE) in this population. The definition of "cancer patient" differs substantially among studies. Whether patients with active cancer and those with a history of cancer (HOC) carry the same risks of recurrent VTE and bleeding remains unclear. Few studies reported data on the efficacy and safety of anticoagulants according to active cancer or HOC categories. While in subgroup analyses of EINSTEIN and HOKUSAI the rates of recurrent VTE and bleeding did not differ between these categories, results from a subgroup analysis of AMPLIFY, from HOKUSAI-Cancer, and from the COMMAND cohort suggest that HOC patients might have a lower bleeding risk than active cancer patients. Whether the inclusion of HOC patients in CAT studies might introduce some bias by decreasing the rates of both recurrent VTE and bleeding remains an unanswered issue since no dedicated prospective study addressed this question. A strict definition of active cancer should be used in further trials.

Direct Oral Anticoagulant for the Treatment of VTE in Cancer Patients: A Systematic Review and Meta-analysis

“…Second, variation in the definitions of cancer patient exists among included RCTs. 21 However, we did not identify heterogeneity between included studies in the 2 subgroups by cancer status. Third, thrombosis and bleeding associated with different cancers are highly heterogeneous, 38 but we were unable to evaluate these outcomes individually by cancer types (eg, solid tumor vs hematological malignancies).…”

“…17 Because several studies suggested that the risk of VTE recurrence was similar between patients with history of cancer and patients with active cancer, [18][19][20] our primary analysis did not distinguish these 2 populations. Meanwhile, because cancer status is an important risk factor for VTE and the definition of cancer patient differs among studies, 21 we further stratified our analysis by patients' cancer status to test the robustness of this decision. For trials that included patients with active cancer and history of cancer, we extracted data for these 2 types of patients separately.…”

Absence of Susceptibility Vessel Sign in Patients With Malignancy-Related Acute Ischemic Stroke Treated With Mechanical Thrombectomy

“…Active malignancy was defined according to the Haemostasis and Malignancy Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis ( 16 , 17 ). Malignancy diagnosed within 1 year after the index stroke was defined as occult malignancy.…”

Impact of malignancy on outcomes in European patients with atrial fibrillation: A report from the ESC‐EHRA EURObservational research programme in atrial fibrillation general long‐term registry

“…14 Nevertheless, specific analyses on real-world AF patients and malignancy are limited, especially with regard to active malignancy. 15 Most of the data are derived from post hoc analyses of randomized controlled trial on selected non-valvular AF patients and a history of cancer, with a small proportion of patients affected by active malignancy [16][17][18] or from observational studies based on administrative data sets. [19][20][21] The management of AF patients and malignancy, therefore, remains an important clinical challenge given the paucity of evidence and lack of clinical trial data.…”