Unanswered questions in cancer‐associated thrombosis

Sanfilippo, Kristen M.; Moik, Florian; Candeloro, Matteo; Ay, Cihan; Nisio, Marcello Di; Lee, Agnes Y.Y.

doi:10.1111/bjh.18276

Cited by 19 publications

(16 citation statements)

References 85 publications

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“…The highest incidence of recurrent VTE is reported in the first 6 months after the index event, thus the majority of cancer patients are treated for at least 6 months. 52 However, cancer patients with certain risk factors (such as metastatic disease, pancreatic or lung cancer, residual vein occlusion) are at particularly high risk of recurrence if anticoagulation is stopped after 6 months. 53 A recent systematic review highlighted that VTE recurrence remains high after 6 months (up to 12%), while major bleeding rates are relatively low (2–5%).…”

Section: Cancer-associated Thrombosismentioning

confidence: 99%

“…Possible hypotheses have been raised to explain the higher bleeding tendency with the DOACs compared to LMWH, such as the local anticoagulant effect of the DOACs at the gastrointestinal absorption site, the lack of antithrombin which is necessary for LMWH activity in the gastrointestinal and genitourinary mucosae, or a possible greater anticoagulant potency of the DOACs. 52 Despite the unavailability of head-to-head comparisons, apixaban seemed to be the DOAC associated with the lowest bleeding risk. 76 …”

Section: Direct Oral Anticoagulants For the Acute Treatment Of Cancer...mentioning

confidence: 99%

“…The highest incidence of recurrent VTE is reported in the first 6 months after the index event, thus the majority of cancer patients are treated for at least 6 months. 52…”

Section: Treatment Of Cat: Secondary Preventionmentioning

confidence: 99%

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Direct Oral Anticoagulants for the Prevention and Acute Treatment of Cancer-Associated Thrombosis

Attard¹,

Gatt²,

Bertoletti³

et al. 2022

VHRM

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Cancer is a major risk factor for venous thromboembolism (VTE), and cancer-associated thrombosis (CAT) constitutes approximately 15–25% of all VTE cases. For decades, the standard treatment for CAT used to be daily subcutaneous low molecular weight heparin (LMWH). Data on the safety and efficacy of the direct oral anticoagulants (DOACs) in this population emerged only in recent years and specific DOACs were included into recent guidelines recommendations. In this narrative review of the literature, we reported the results of the phase III randomized controlled trials that evaluated the DOACs for the prevention and the acute treatment of CAT. For the acute phase treatment, the anti-Xa inhibitors (apixaban, edoxaban, rivaroxaban) showed better efficacy than LMWH in preventing VTE recurrence; however, rivaroxaban and edoxaban were also associated with an increased risk of bleeding events. For primary prevention of CAT in ambulatory cancer patients starting chemotherapy, apixaban and rivaroxaban showed better efficacy than placebo but a trend towards higher bleeding rates. Recent guidelines suggest the DOACs for the treatment of CAT in selected cancer patients (eg, low bleeding risk, no luminal gastrointestinal or genitourinary malignancies, no interfering medications). The DOACs are also suggested for primary thromboprophylaxis in selected ambulatory cancer patients at high risk of VTE (eg, Khorana score ≥2 prior to starting new chemotherapy, low bleeding risk, no interfering medications).

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Section: Cancer-associated Thrombosismentioning

confidence: 99%

Section: Direct Oral Anticoagulants For the Acute Treatment Of Cancer...mentioning

confidence: 99%

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Direct Oral Anticoagulants for the Prevention and Acute Treatment of Cancer-Associated Thrombosis

Attard¹,

Gatt²,

Bertoletti³

et al. 2022

VHRM

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“…Another interesting algorithm recently proposed by Sanfilippo and colleagues regards extended anticoagulation therapy beyond six months ( Figure 2 ) [ 77 ].…”

Section: Pathophysiology Of Vte In Cancer Patientsmentioning

confidence: 99%

“… Extended anticoagulation therapy beyond six months (modified by ref. [ 77 ]). VTE—venous thromboembolism.…”

Section: Figurementioning

confidence: 99%

Multidisciplinary Care for the Prevention and Treatment of Venous Thromboembolism in Patients with Cancer-Associated Thrombosis (CAT): Impact of Educational Interventions on CAT-Related Events and on Patients’ and Clinicians’ Awareness

Zalunardo

Panzavolta

Bigolin

et al. 2022

Life

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Cancer is a leading cause of death. Venous thromboembolism (VTE) is an often-overlooked cause of morbidity and mortality in cancer patients that can be readily prevented and treated. Actions are needed to reduce the morbidity and mortality of patients with cancer-associated thrombosis (CAT). There is a need to increase awareness of the impact of CAT on cancer patients’ morbidity and mortality, on their quality of life and to understand the importance of more effective preventions and treatments of VTE in cancer patients. Moreover, it is of great importance to systematically assess the risk of VTE in regard to patients, cancer and treatment-related factors. Unfortunately, there are unmet clinical needs in the prevention and treatment of cancer-associated VTE. In this review, we discuss an action plan to ensure an increased awareness of and education on the issues that need to be addressed in order to improve the provision of appropriate prevention, early diagnosis and effective and safe treatment of VTE to all cancer patients and, ultimately, to reduce morbidity and mortality.

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Underlying Mechanisms of Thrombosis Associated with Cancer and Anticancer Therapies

Pantazi,

Alivertis,

Tselepis

2024

Curr. Treat. Options in Oncol.

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Unanswered questions in cancer‐associated thrombosis

Cited by 19 publications

References 85 publications

Direct Oral Anticoagulants for the Prevention and Acute Treatment of Cancer-Associated Thrombosis

Direct Oral Anticoagulants for the Prevention and Acute Treatment of Cancer-Associated Thrombosis

Multidisciplinary Care for the Prevention and Treatment of Venous Thromboembolism in Patients with Cancer-Associated Thrombosis (CAT): Impact of Educational Interventions on CAT-Related Events and on Patients’ and Clinicians’ Awareness

Underlying Mechanisms of Thrombosis Associated with Cancer and Anticancer Therapies

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