Direct Oral Anticoagulants in Cancer Patients. Time for a Change in Paradigm

Abstract

Thrombosis is a more common occurrence in cancer patients compared to the general population and is one of the main causes of death in these patients. Low molecular weight heparin (LMWH) has been the recognized standard treatment for more than a decade, both in cancer-related thrombosis and in its prevention. Direct oral anticoagulants (DOACs) are a new option for anticoagulation therapy. Recently published results of large randomized clinical trials have confirmed that DOAC may be a reasonable alternative to LMWH in cancer patients. The following review summarizes the current evidence on the safety and efficacy of DOAC in the treatment and prevention of cancer-related thrombosis. It also draws attention to the limitations of this group of drugs, knowledge of which will facilitate the selection of optimal therapy.

Advances in the Prediction and Risk Assessment of Lung Cancer-Associated Venous Thromboembolism

“… 57 In addition, recent RCTs have demonstrated that DOACs could represent an alternative option. 58 However, whether lung cancer patients should receive routine anticoagulation therapy is still under investigation and requires more prospective studies. Management of VTE in patients with lung cancer is currently a therapeutic challenge and remains controversial worldwide.…”

Diagnostic and Therapeutic Challenges of Cerebral Venous Thrombosis in SARS-CoV-2 Infection: A Case Report and Review of Literature

“…The use of anticoagulation has been proven to be safe and effective, as it is directed towards the underlying pathology of thrombosis. In patients with cancers associated with acute thrombosis, the use of DOACs is preferred over low molecular weight heparin (LMWH), with the exception of gastrointestinal or urological cancers [ 26 ]. The gold-standard, long-term treatment of CVT is warfarin, with a target INR of 2.0–3.0 [ 4 , 6 ].…”

“…The gold-standard, long-term treatment of CVT is warfarin, with a target INR of 2.0–3.0 [ 4 , 6 ]. Warfarin has been reported to be the most effective anticoagulation therapy, compared to DOACs, in patients with antiphospholipid syndrome, prosthetic valves, and those with high risk of gastrointestinal bleeds [ 26 , 27 ]. For warfarin to be therapeutic, prolonged stays in the hospital are required, with additional long-term outpatient INR monitoring.…”

Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer

“…The use of DOACs in VTE treatment and primary prevention in cancer patients is the focus of the review by Wojtukiewicz and coworkers [ 16 ]. LMWH has been the recognized standard drug for more than a decade, until recent published results of large randomized clinical trials have confirmed that DOACs may represent a reasonable alternative to LMWH in cancer patients—both in terms of efficacy and safety—and a valuable step forward in the treatment and prevention of cancer-related thrombosis [ 16 ]. As stated above, DOACs are an alternative to LMWH in the recommendations of expert societies [ 14 , 15 , 16 ] both in the treatment of cancer-associated thrombosis and in VTE primary prevention in high-risk patients [ 15 , 16 ].…”

“…LMWH has been the recognized standard drug for more than a decade, until recent published results of large randomized clinical trials have confirmed that DOACs may represent a reasonable alternative to LMWH in cancer patients—both in terms of efficacy and safety—and a valuable step forward in the treatment and prevention of cancer-related thrombosis [ 16 ]. As stated above, DOACs are an alternative to LMWH in the recommendations of expert societies [ 14 , 15 , 16 ] both in the treatment of cancer-associated thrombosis and in VTE primary prevention in high-risk patients [ 15 , 16 ]. Limitations of DOACs are also discussed, including the increased risk of major bleeding, interaction with other drugs, unknown or inappropriate pharmacokinetics in patients with large deviations from normal body weight and in patients with impaired renal function, corroborating the need for careful patient selection [ 16 ].…”