Risks and Benefits of Anticoagulation in Cancer and Noncancer Patients

Abstract

Venous thromboembolism (VTE) is a common complication of cancer occurring in up to one-fifth of cancer patients. The risk of VTE, which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is increased up to seven-fold in patients with cancer. While the indications and contraindications to treatment for VTE patients with cancer parallel to those patients without cancer, the treatment of VTE is challenging for cancer patients who are three-fold more likely to have VTE recurrence than patients without cancer and who are also at increased risk of bleeding. While anticoagulant therapy is recommended for most cancer patients with VTE, some patients may benefit from alternative interventions, such as thrombolysis, thromboembolectomy, or placement of an inferior vena cava (IVC) filter. Recent data support the use of direct oral anticoagulants (DOACs) for treatment of cancer-associated VTE in select cancer patients and for primary prevention of thromboembolism in high-risk cancer patients. Individualized decision-making, keeping in consideration the patient's risk for thrombotic and bleeding events is essential.

Intraoperative considerations in a patient with chondroblastic osteosarcoma and saddle pulmonary embolism undergoing amputation

“…The risk of venous thrombosis and pulmonary embolism (PE) is increased up to sevenfold in patients with cancer. 10 The overall incidence for venous thromboembolism with Osteosarcoma is more common compared to other sarcomas (17%), behind only malignant peripheral nerve sheath tumor (27%). In osteosarcoma patients, thromboembolism is more frequently located in the lower extremities and typically occurs in older patients.…”

“…11 Venous thromboembolism and pulmonary embolism in cancer patients can be prevented with the use of anticoagulation, especially in high-risk patients. 10 Alteplase (tPA) is the only thrombolytic approved for the treatment of PE in the United States and is currently used for the treatment of PE with hemodynamic instability. 12 This case demonstrates the importance of multidisciplinary preoperative planning as well as the role TEE can play in intraoperative management.…”

Cancer Risk in the Heart Failure Population: Epidemiology, Mechanisms, and Clinical Implications

“…As stated above, AF is a common comorbidity in both HF and cancer patients, and it is also a possible side effect of some anticancer treatments [91, 92, 94•]. In recent years, direct oral anticoagulants are being preferred to warfarin thanks to their safety profile [96]. Moreover, HF-cancer patients have a higher risk of developing deep venous thrombosis and pulmonary embolisms, as well as central venous catheter thrombosis [96].…”

“…In recent years, direct oral anticoagulants are being preferred to warfarin thanks to their safety profile [96]. Moreover, HF-cancer patients have a higher risk of developing deep venous thrombosis and pulmonary embolisms, as well as central venous catheter thrombosis [96]. For this reason, it is fundamental for the cardio-oncology team to stratify the thrombosis/bleeding risk for each HF-cancer patient and decide whether anticoagulation treatment is required and which anticoagulants are to be chosen among low-weight heparin and direct oral anticoagulants, considering among all possible drug interactions [97••].…”

Epidemiology, Prevention, Diagnosis, and Management of Venous Thromboembolism in Gastrointestinal Cancers

“…32 Prophylactic anticoagulation is also recommended for hospitalized patients with cancer and patients with cancer under-going major surgical intervention with data supporting these recommendations. 32,33…”