Management of Cancer-Associated Thrombosis

AbstractPurpose of reviewLow molecular weight heparin (LMWH) has been the standard of care for patients with cancer-associated thrombosis (CAT) for over 10  years; however, its adoption has been limited. The appearance of direct acting oral anticoagulants (DOACs) revolutionized the treatment of non-cancer venous thromboembolism (VTE) through their attractive fixed dose regimens; however, a lack of dedicated trial experience had relegated their positio n to off-label use in patients with cancer. The goal of this review is to review the evidence that has been generated over the last 3 years for factor Xa inhibitors, summarize their current position in the guidelines, and highlight areas of ongoing uncertainty with respect to the management of CAT.Recent findingsFour dedicated trials of patients with CAT have been published comparing edoxaban, rivaroxaban, or apixaban with the LMWH, dalteparin. While these trials all have differences in sample size and inclusion/exclusion criteria, the totality of evidence suggests these agents have similar (if not superior) efficacy for reducing the risk of VTE recurrence without a significant excess in major bleeding. These overall favorable results have translated to guideline recommendations with caveats for patients at high bleeding risk or those with anticipated drug-drug interactions.SummaryDirect-oral anticoagulants now feature prominently in the treatment guidelines for patients with CAT. These agents are, however, not for eve...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research

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Conclusion: In this meta-analysis, we found that DOACs not only significantly decreased the risk of VTE or recurrent VTE in patients with cancer but also significantly increased the risk of bleeding and CRNMB, with neither beneficial nor detrimental effects on survival. The quantification of these benefits and risks will assist in individualised shared decision-making. PMID: 33014133 [PubMed]
Source: Ecancermedicalscience - Category: Cancer & Oncology Tags: Ecancermedicalscience Source Type: research
CONCLUSION: Since thrombocytopenia, thrombosis recurrence, and bleeding are common in tumor patients, the selection of anticoagulants in this circumstance is a considerable challenge for clinicians. PMID: 32951561 [PubMed - as supplied by publisher]
Source: Vascular - Category: Surgery Authors: Tags: Vascular Source Type: research
CONCLUSION AND RELEVANCE: DOACs have better efficacy to prevent recurrent VTE compared with conventional therapy. Regarding the safety profile, DOACs may carry higher risk of bleeding compared with LMWH but lower risk of bleeding compared with VKAs. Further studies are needed to inform the optimal anticoagulation approach for different types of cancers. PMID: 32938202 [PubMed - as supplied by publisher]
Source: The Annals of Pharmacotherapy - Category: Drugs & Pharmacology Authors: Tags: Ann Pharmacother Source Type: research
Authors: Overvad TF, Larsen TB, Søgaard M, Albertsen IE, Ording AG, Noble S, Højen AA, Nielsen PB Abstract INTRODUCTION: Cancer-associated venous thromboembolism remains an important but challenging aspect in the treatment of patients with cancer. Recently, alternatives to injection of low-molecular-weight heparin (LMWH) have been introduced, the non-vitamin K antagonist oral anticoagulants (NOACs), which could potentially alleviate patients from burdensome daily injections. AREAS COVERED: This review discusses the available evidence exploring the role of NOACs in the treatment and secondary preve...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
The CARAVAGGIO clinical trial has clearly been a landmark study that established the important role for direct oral anticoagulants (DOACs), especially apixaban as a treatment for venous thromboembolism (VTE) in cancer [1]. The study clearly showed that apixaban was non-inferior to subcutaneous dalteparin for the treatment of cancer associated VTE without an increased risk of major bleeding.
Source: Thrombosis Research - Category: Hematology Authors: Tags: Editorial Source Type: research
CONCLUSIONS: Apixaban is more cost-effective than enoxaparin for the prevention of postoperative VTE in patients with gynecologic cancer. This appears to be driven largely by DVT and CRNMB prevention. PMID: 32854972 [PubMed - as supplied by publisher]
Source: Gynecologic Oncology - Category: Cancer & Oncology Authors: Tags: Gynecol Oncol Source Type: research
This study aimed to assess the effectiveness of DOACs versus warfarin for the prevention of recurrent VTE and major bleeding events in patients with VTE and active cancer. METHODS: We identified patients with incident VTE and active cancer who newly initiated treatment with DOACs or warfarin from Truven Health MarketScan Commercial Claims and Medicare supplemental databases. Patients were followed up from treatment initiation (index date) until the occurrence of>7-day gap in treatment, the start of the study comparator, an outcome of interest (recurrent VTE or major bleeding), inpatient death, disenrollment, or end...
Source: Clinical Therapeutics - Category: Drugs & Pharmacology Authors: Tags: Clin Ther Source Type: research
minique Farge Patients with pancreatic cancer (PC) carry the highest risk of venous thromboembolism (VTE) amongst all cancer patients. Appropriate use of primary thromboprophylaxis might significantly and safely reduce its burden. We performed a systematic review of published studies and meeting abstracts using MEDLINE and EMBASE through July 2020 to evaluate the efficacy and safety of primary thromboprophylaxis in ambulatory PC patients receiving chemotherapy. The Mantel–Haenszel random effect model was used to estimate the pooled event-based risk ratio (RR) and the pooled absolute risk difference (RD) with ...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
Discussion Pediatric cancers in the US number about 12,000 per year. After injury, it is the second leading cause of death in children and adolescents. Cancer presentations vary widely, but often begin with non-specific symptoms that continue or progress depending on the location and tumor type. Patients can present with oncological emergencies especially if there are mechanical obstruction such as superior vena cava syndrome or cerebral herniation. More commonly are infections due to immunosuppression. Cancer treatment also causes its own myriad of problems that clinicians need to be aware of to diagnosis and treat, but a...
Source: - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
ConclusionsThe effects of DOACs on delayed bleeding varied between agents, but dabigatran therapy was associated with the lowest risk of delayed bleeding. Switching oral anticoagulants to dabigatran during the perioperative period could be a reasonable option to reduce the risk of delayed bleeding after gastric ESD.
Source: Gastric Cancer - Category: Gastroenterology Source Type: research
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