Oral anticoagulation in people with cancer who have no therapeutic or prophylactic indication for anticoagulation

Abstract

The existing evidence does not show a mortality benefit from oral anticoagulation in people with cancer but suggests an increased risk for bleeding.Editorial note: this is a living systematic review. Living systematic reviews offer a new approach to review updating in which the review is continually updated, incorporating relevant new evidence, as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

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

“…Kahale, LA. [11] 2017; 1486 pts DOACs do not decrease mortality in cancer patients but may be responsible for more bleeding events [10].…”

“…For long-term therapy for cancer-associated thrombotic events, DOACs, as compared to LMWH, may have an efficient antithrombotic effect, but safety issues arise because of an increased risk of major bleeding [11].…”

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

“…Kahale, LA. [11] 2017; 1486 pts DOACs do not decrease mortality in cancer patients but may be responsible for more bleeding events [10].…”

“…For long-term therapy for cancer-associated thrombotic events, DOACs, as compared to LMWH, may have an efficient antithrombotic effect, but safety issues arise because of an increased risk of major bleeding [11].…”

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

“…The combinatorial treatment with anticoagulant use provided extra tumor reduction by 24.3% compared to treatment with the drug only [ 34 ]. Other recent studies also suggest that anticoagulants improve survival in cancer patients through antitumor effects in addition to antithrombotic effects [ 35 , 36 , 37 ]. Although those studies do not specifically focus on pancreatic cancer, their conclusions are relevant to our finding that long-term systemic anticoagulation use was associated with better inpatient outcomes.…”

Association between Radiotherapy and Risk of Cancer Associated Venous Thromboembolism: A Sub-Analysis of the COMPASS—CAT Study

“…It reduces symptomatic VTE; however, increases the likelihood of major and minor bleeding. Reports from a recent living systemic review that included randomized controlled trials assessing the benefits and harms of vitamin K antagonists or direct oral anticoagulants in ambulatory patients with cancer did not show a mortality benefit from oral anticoagulation, but suggested an increased risk for bleeding [ 29 ]. Also, the RIETE registry showed that patients treated with radiotherapy are two times more likely to develop cerebral bleeding once started on therapeutic anticoagulation [ 30 ], which further strengthens the need to properly identify high risk groups, and the possible role of thromboprophylaxis to prevent both thrombotic and bleeding complications.…”

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

“…Kahale, LA. [11] 2017; 1486 pts DOACs do not decrease mortality in cancer patients but may be responsible for more bleeding events [10].…”

“…For long-term therapy for cancer-associated thrombotic events, DOACs, as compared to LMWH, may have an efficient antithrombotic effect, but safety issues arise because of an increased risk of major bleeding [11].…”

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

“…The combinatorial treatment with anticoagulant use provided extra tumor reduction by 24.3% compared to treatment with the drug only [ 34 ]. Other recent studies also suggest that anticoagulants improve survival in cancer patients through antitumor effects in addition to antithrombotic effects [ 35 , 36 , 37 ]. Although those studies do not specifically focus on pancreatic cancer, their conclusions are relevant to our finding that long-term systemic anticoagulation use was associated with better inpatient outcomes.…”

Association between Radiotherapy and Risk of Cancer Associated Venous Thromboembolism: A Sub-Analysis of the COMPASS—CAT Study

“…It reduces symptomatic VTE; however, increases the likelihood of major and minor bleeding. Reports from a recent living systemic review that included randomized controlled trials assessing the benefits and harms of vitamin K antagonists or direct oral anticoagulants in ambulatory patients with cancer did not show a mortality benefit from oral anticoagulation, but suggested an increased risk for bleeding [ 29 ]. Also, the RIETE registry showed that patients treated with radiotherapy are two times more likely to develop cerebral bleeding once started on therapeutic anticoagulation [ 30 ], which further strengthens the need to properly identify high risk groups, and the possible role of thromboprophylaxis to prevent both thrombotic and bleeding complications.…”

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

“…Kahale, LA. [11] 2017; 1486 pts DOACs do not decrease mortality in cancer patients but may be responsible for more bleeding events [10].…”

“…For long-term therapy for cancer-associated thrombotic events, DOACs, as compared to LMWH, may have an efficient antithrombotic effect, but safety issues arise because of an increased risk of major bleeding [11].…”

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

“…The combinatorial treatment with anticoagulant use provided extra tumor reduction by 24.3% compared to treatment with the drug only [ 34 ]. Other recent studies also suggest that anticoagulants improve survival in cancer patients through antitumor effects in addition to antithrombotic effects [ 35 , 36 , 37 ]. Although those studies do not specifically focus on pancreatic cancer, their conclusions are relevant to our finding that long-term systemic anticoagulation use was associated with better inpatient outcomes.…”

Association between Radiotherapy and Risk of Cancer Associated Venous Thromboembolism: A Sub-Analysis of the COMPASS—CAT Study

“…It reduces symptomatic VTE; however, increases the likelihood of major and minor bleeding. Reports from a recent living systemic review that included randomized controlled trials assessing the benefits and harms of vitamin K antagonists or direct oral anticoagulants in ambulatory patients with cancer did not show a mortality benefit from oral anticoagulation, but suggested an increased risk for bleeding [ 29 ]. Also, the RIETE registry showed that patients treated with radiotherapy are two times more likely to develop cerebral bleeding once started on therapeutic anticoagulation [ 30 ], which further strengthens the need to properly identify high risk groups, and the possible role of thromboprophylaxis to prevent both thrombotic and bleeding complications.…”