Cancer-Associated Venous Thromboembolism: A Practical Review Beyond Low-Molecular-Weight Heparins

• Main Authors: Alannah Smrke, Peter L. Gross
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2017-08-01
• Series: Frontiers in Medicine
• Subjects: cancer-associated venous thromboembolism; cancer-associated thrombosis; venous thromboembolism; pulmonary embolism; low-molecular-weight heparin; direct oral anticoagulants
• Online Access: http://journal.frontiersin.org/article/10.3389/fmed.2017.00142/full

Patients with cancer are at significantly higher risk of developing, and dying from, venous thromboembolism (VTE). The CLOT trial demonstrated superiority of low-molecular-weight heparins (LMWH) over warfarin for recurrent VTE and established LMWH as the standard of care for cancer-associated VTE. However, with patients living longer with metastatic cancer, long-term injections are associated with significant cost and injection fatigue. Direct oral anticoagulants (DOACs) are an attractive alternative for treatment of cancer-associated VTE. Meta-analysis of subgroup data of patients with cancer from the large DOAC VTE trials and small non-randomized studies have found no difference in VTE recurrence or major bleeding. With this limited evidence, clinicians may decide to switch their patients who require long-term anticoagulation from LMWH to a DOAC. This requires careful consideration of the interplay between the patient’s cancer and treatment course, with their underlying comorbidities.