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.

Exploring the Cardiotoxicity Spectrum of Anti-Cancer Treatments: Definition, Classification, and Diagnostic Pathways

“…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 ].…”

Exploring the Cardiotoxicity Spectrum of Anti-Cancer Treatments: Definition, Classification, and Diagnostic Pathways

“…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 ].…”

Severe Thrombocytopenia as a Manifestation of COVID-19 Infection

“…After 6 weeks, the platelet count was increased to the lower limit of normal range and Medrol was discontinued. Oral anticoagulant was administered after purpuric lesions disappeared and platelet count exceeded 100,000/mm 3 [8]. Urological evaluation was recommended at discharge.…”

Personalized Anticoagulation in Cancer Patients: Current Evidence and Future Perspectives

“…Cancer-associated thrombosis (CAT) is a challenging condition at the intersection of oncology, hematology, and cardiovascular medicine. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality in cancer patients and remains the second most common cause of death after cancer progression in those receiving systemic anticancer therapy [ 1 ]. Compared with the general population, patients with malignancy have a four- to sevenfold higher risk of developing VTE, although this risk varies by tumor type, disease stage, anticancer treatment, hospitalization, surgery, immobility, and the presence of central venous catheters [ 2 , 3 ].…”

“…Tumor location, mucosal involvement, thrombocytopenia, renal or hepatic dysfunction, recent surgery, invasive procedures, drug–drug interactions, and cancer-directed therapies all affect both the efficacy and safety of anticoagulant treatment. As a result, the management of CAT goes beyond selecting an anticoagulant and requires the continuous review of thrombotic and bleeding risks, treatment tolerability, and changes in the patient’s clinical status throughout the course of cancer care [ 1 , 2 , 5 ].…”

“…Cancer-associated thrombosis (CAT) is a challenging condition at the intersection of oncology, hematology, and cardiovascular medicine. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality in cancer patients and remains the second most common cause of death after cancer progression in those receiving systemic anticancer therapy [1].…”

Exploring the Cardiotoxicity Spectrum of Anti-Cancer Treatments: Definition, Classification, and Diagnostic Pathways

“…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 ].…”

Severe Thrombocytopenia as a Manifestation of COVID-19 Infection

“…After 6 weeks, the platelet count was increased to the lower limit of normal range and Medrol was discontinued. Oral anticoagulant was administered after purpuric lesions disappeared and platelet count exceeded 100,000/mm 3 [8]. Urological evaluation was recommended at discharge.…”

Personalized Anticoagulation in Cancer Patients: Current Evidence and Future Perspectives

“…Cancer-associated thrombosis (CAT) is a challenging condition at the intersection of oncology, hematology, and cardiovascular medicine. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality in cancer patients and remains the second most common cause of death after cancer progression in those receiving systemic anticancer therapy [ 1 ]. Compared with the general population, patients with malignancy have a four- to sevenfold higher risk of developing VTE, although this risk varies by tumor type, disease stage, anticancer treatment, hospitalization, surgery, immobility, and the presence of central venous catheters [ 2 , 3 ].…”

“…Tumor location, mucosal involvement, thrombocytopenia, renal or hepatic dysfunction, recent surgery, invasive procedures, drug–drug interactions, and cancer-directed therapies all affect both the efficacy and safety of anticoagulant treatment. As a result, the management of CAT goes beyond selecting an anticoagulant and requires the continuous review of thrombotic and bleeding risks, treatment tolerability, and changes in the patient’s clinical status throughout the course of cancer care [ 1 , 2 , 5 ].…”

“…Cancer-associated thrombosis (CAT) is a challenging condition at the intersection of oncology, hematology, and cardiovascular medicine. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality in cancer patients and remains the second most common cause of death after cancer progression in those receiving systemic anticancer therapy [1].…”

Exploring the Cardiotoxicity Spectrum of Anti-Cancer Treatments: Definition, Classification, and Diagnostic Pathways

“…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 ].…”

Severe Thrombocytopenia as a Manifestation of COVID-19 Infection

“…After 6 weeks, the platelet count was increased to the lower limit of normal range and Medrol was discontinued. Oral anticoagulant was administered after purpuric lesions disappeared and platelet count exceeded 100,000/mm 3 [8]. Urological evaluation was recommended at discharge.…”

Personalized Anticoagulation in Cancer Patients: Current Evidence and Future Perspectives

“…Cancer-associated thrombosis (CAT) is a challenging condition at the intersection of oncology, hematology, and cardiovascular medicine. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality in cancer patients and remains the second most common cause of death after cancer progression in those receiving systemic anticancer therapy [ 1 ]. Compared with the general population, patients with malignancy have a four- to sevenfold higher risk of developing VTE, although this risk varies by tumor type, disease stage, anticancer treatment, hospitalization, surgery, immobility, and the presence of central venous catheters [ 2 , 3 ].…”

“…Tumor location, mucosal involvement, thrombocytopenia, renal or hepatic dysfunction, recent surgery, invasive procedures, drug–drug interactions, and cancer-directed therapies all affect both the efficacy and safety of anticoagulant treatment. As a result, the management of CAT goes beyond selecting an anticoagulant and requires the continuous review of thrombotic and bleeding risks, treatment tolerability, and changes in the patient’s clinical status throughout the course of cancer care [ 1 , 2 , 5 ].…”

“…Cancer-associated thrombosis (CAT) is a challenging condition at the intersection of oncology, hematology, and cardiovascular medicine. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality in cancer patients and remains the second most common cause of death after cancer progression in those receiving systemic anticancer therapy [1].…”