Practical considerations for the use of direct oral anticoagulants in oncology patients

Abstract

Oncology patients are at a high risk of experiencing venous thromboembolism. Historically, venous thromboembolisms in cancer patients have been managed with low-molecular-weight heparin on the basis of the CLOT trial published in 2003. However, recent prospective data provide evidence for safe and effective direct oral anticoagulant use in this population. The purpose of this review article is to evaluate the current body of literature surrounding direct oral anticoagulant use in the oncology population and to highlight key practical considerations when prescribing these agents for patients with cancer.

Practical Considerations for the Management of Cancer-Associated Venous Thromboembolism: A Guide for the General Oncology Practitioner

“…The most frequently encountered issue that affects oral intake in patients with cancer is nausea and/or vomiting, especially when receiving highly emetogenic anticancer treatment [ 55 ]. In particular, the bioavailability and part of the absorption of rivaroxaban are dependent on the acidic environment of the stomach and, therefore, must be taken with food [ 56 ]. Altered GI tract anatomy should also be considered as surgical resection of the stomach, small bowel, or ascending colon is hypothesized to lead to reduced DOAC absorption [ 25 , 57 ].…”