Arguments for Using Direct Oral Anticoagulants in Cancer-Related Venous Thromboembolism

Abstract

(1) Background: Patients with cancer with a hypercoagulable state present an increased incidence of venous thromboembolism (VTE). Neoplastic patients with concurrent VTE undergoing anticoagulant treatment face a series of issues. (2) The aim of the present paper is to systematically summarize current VTE management in patients with neoplasia and to review the current clinical evidence from meta-analyses of randomized controlled trials and guidelines regarding the administration of direct oral anticoagulants (DOACs) for cancer-associated VTE. (3) Search Strategy: We performed a review on meta-analyses of randomized controlled trials and guidelines in favor of the administration of DOACs in patients with cancer-associated VTE published in the last 6 years in the Medline (PubMed) and Embase databases. (4) Results: 21 meta-analyses, 14 randomized controlled studies comparing DOACs to VKAs and LMWH, and 7 national and international guidelines were identified. We identified five studies that show the antineoplastic effect of DOAC on experimental models. (5) Conclusions: DOACs can be seen as the first choice for VTE treatment in neoplastic patients who have a low risk of bleeding, who do not have severe renal impairment, and who are not undergoing treatments that could interact with DOAC’s mechanism of action.

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“…In this regard, it should be noted that VTE is among the most frequent causes of death after cancer surgery [ 2 ]. Recommendations for both prophylaxis and treatment of VTE in patients with cancer and COVID-19 are similar to those of patients without COVID-19 [ 24 , 25 ]. As a note, intra-arterial thrombotic events may also but rarely occur in cancer patients under anthracyclines, taxanes, and platinum-based chemotherapies [ 2 , 26 ].…”

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