Current status of treatment of cancer-associated venous thromboembolism

Abstract

Patients with cancer are prone to develop venous thromboembolism (VTE) that is the second leading cause of mortality among them. Cancer patients with VTE may encounter higher rates of VTE recurrence and bleeding complications than patients without cancer. Treatment of established VTE is often complex in patients with cancer. Treatment of cancer-associated VTE basically comprises initial treatment, long-term treatment, treatment within 6 months, treatment beyond 6 months, treatment of recurrent VTE, and treatment in special situations. Decision of antithrombotic therapy, selection of anticoagulants, duration of anticoagulation, decision of adjuvant therapy, and adjustment of regimen in special situations are the major problems in the treatment of cancer-associated VTE. Therapeutic anticoagulation is the key of the key in the treatment of cancer-associated VTE. In addition to the efficacy and safety of low-molecular-weight heparin (LMWH) that has been fully demonstrated, direct oral anticoagulants (DOACs) are increasingly showing its advantages along with the accompanying concern in the treatment of cancer-associated VTE. The latest ASCO, ITAC and NCCN guidelines agree with each other on most aspects with respect to the treatment of cancer-associated VTE, whereas differ on a few issues. Encompassing recent randomized controlled trials, clinical trials, and meta-analyses, as well as the comparison of the latest authoritative guidelines including the NCCN, ASCO, and ITAC guidelines in this field, the objective of this review is to present current overview and recommendations for the treatment of cancer-associated VTE.

Characteristics and Outcomes of Patients Consulted by a Multidisciplinary Pulmonary Embolism Response Team: 5-Year Experience

“…LMWH was received by a substantial number of patients at discharge (35.0%), the majority of whom presented with a co-existing malignancy. The choice of anticoagulation for cancer-associated VTE is a major therapeutic challenge due to a delicate balance between the recurrent thromboembolic and bleeding events in these patients [20]. LMWH has traditionally been the standard treatment for cancer-associated VTE due to higher efficacy and comparable safety, compared to VKA [21].…”

The Role of Direct Oral Anticoagulants in Cancer-Associated Thrombosis According to the Current Literature

“…However, it is of note that all three treatment options were equal regarding all-cause mortality [ 38 ]. Patients’ preference over an oral anticoagulant than an injectable LMWH may affect the final clinical decision [ 40 ].…”

Map of thrombogenesis in viral infections and viral-driven tumours

“…Armand Trousseau first observed the association between malignant disease and thromboembolism in the nineteenth century by realizing the major medical impact this haemostatic disorder had on cancer patients’ prognosis [ 30 ]. In fact, the blood hypercoagulation state in the context of cancer followed by the diagnosis of VTE, known as the Trousseau syndrome, is nowadays remarkably well-recognized and, aside from the malignant neoplasia itself, is the second most frequent cause of death among these patients [ 31 , 32 ]. Several studies have demonstrated a growing incidence of cancer-related thrombosis, which can be explained by patient- (e.g., advanced age), cancer biology- (e.g., primary tumour site, histology, size and stage) and cancer treatment-related factors (e.g., surgery, chemotherapy and radiotherapy) [ 28 , 30 , 33 , 34 ].…”