Download PDF
CC BY 4.0 · TH Open 2021; 05(03): e376-e386
DOI: 10.1055/s-0041-1736037
Original Article

Management of Cancer-Associated Thrombosis: Unmet Needs and Future Perspectives

Anna Falanga 
1   Department of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Monza, Italy
2   Department of Immunohematology and Transfusion Medicine, Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy
,
Grégoire Le Gal
3   Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
,
Marc Carrier
3   Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
,
Hikmat Abdel-Razeq
4   Department of Medicine, King Hussein Cancer Center, Amman, Jordan
,
Cihan Ay
5   Clinical Division of Haematology and Haemostaseology, Department of Internal Medicine, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
6   Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
,
Andrés J. Muñoz Martin
7   Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
,
Ana Thereza Cavalcanti Rocha
8   Departamento de Saúde da Família, Faculdade de Medicina da Bahia, Universidade Federal da Bahia – UFBA, Salvador, BA, Brazil
,
Giancarlo Agnelli
9   Internal Vascular and Emergency Medicine – Stroke Unit, University of Perugia, Perugia, Italy
,
Ismail Elalamy
6   Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
10   Hematology and Thrombosis Centre, Hôpital Tenon, INSERM U938, Sorbonne Université, AP-HP, Paris, France
,
Benjamin Brenner
6   Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
11   Department of Hematology, Rambam Health Care Campus, Haifa, Israel
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Patients with cancer are at a high risk of symptomatic venous thromboembolism (VTE), which is a common cause of morbidity and mortality in this patient population. Increased risk of recurrent VTE and bleeding complications are two major challenges associated with therapeutic anticoagulation in these patients. Long-term therapy with low-molecular-weight heparins (LMWHs) has been the standard of care for the treatment of cancer-associated VTE given its favorable risk–benefit ratio in comparison with vitamin K antagonists. Direct oral anticoagulants (DOACs), which offer the convenience of oral administration and have a rapid onset of action, have recently emerged as a new treatment option for patients with cancer-associated thrombosis (CT). Randomized clinical trial data with head-to-head comparisons between DOACs and LMWHs showed that overall, DOACs have a similar efficacy profile but a higher risk of bleeding was observed in some of these studies. This review aims to identify unmet needs in the treatment of CT. We discuss important considerations for clinicians tailoring anticoagulation (1) drug–drug interactions, (2) risk of bleeding (e.g., gastrointestinal bleeding), (3) thrombocytopenia, hematological malignancies, (4) metastatic or primary brain tumors, and (5) renal impairment. Additional research is warranted in several clinical scenarios to help clinicians on the best therapeutic approach.

Keywords

cancer - thrombosis - DVT - VTE - PE - thrombocytopenia - LMWH - DOACs

Disclosure

The content of the publication originated following a discussion at an advisory board meeting for which the authors received honoraria from Sanofi. However, the authors received no payment from Sanofi directly or indirectly (through a third party) related to the development/presentation of this publication.


Author Contributions

All authors were involved in the conception of the work, critically revising the manuscript, have provided the final approval, and take full accountability for the work, for all content and editorial decisions.




Publication History

Received: 26 February 2021

Accepted: 29 June 2021

Article published online:
31 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Abdol Razak NB, Jones G, Bhandari M, Berndt MC, Metharom P. Cancer-associated thrombosis: an overview of mechanisms, risk factors, and treatment. Cancers (Basel) 2018; 10 (10) E380
    CrossrefPubMedSearch in Google Scholar
  • 2 Prandoni P, Falanga A, Piccioli A. Cancer and venous thromboembolism. Lancet Oncol 2005; 6 (06) 401-410
    CrossrefPubMedSearch in Google Scholar
  • 3 Mulder FI, Horváth-Puhó E, van Es N. et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood 2021; 137 (14) 1959-1969
    CrossrefPubMedSearch in Google Scholar
  • 4 Fuentes HE, Tafur AJ, Caprini JA. Cancer-associated thrombosis. Dis Mon 2016; 62 (05) 121-158
    CrossrefPubMedSearch in Google Scholar
  • 5 Al-Samkari H, Connors JM. Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy. Blood Adv 2019; 3 (22) 3770-3779
    CrossrefPubMedSearch in Google Scholar
  • 6 Khorana AA, Dalal M, Lin J, Connolly GC. Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United States. Cancer 2013; 119 (03) 648-655
    CrossrefPubMedSearch in Google Scholar
  • 7 Khorana AA, Francis CW, Culakova E, Lyman GH. Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study. Cancer 2005; 104 (12) 2822-2829
    CrossrefPubMedSearch in Google Scholar
  • 8 Grilz E, Königsbrügge O, Posch F. et al. Frequency, risk factors, and impact on mortality of arterial thromboembolism in patients with cancer. Haematologica 2018; 103 (09) 1549-1556
    CrossrefPubMedSearch in Google Scholar
  • 9 Moik F, Chan WE, Wiedemann S. et al. Incidence, risk factors, and outcomes of venous and arterial thromboembolism in immune checkpoint inhibitor therapy. Blood 2021; 137 (12) 1669-1678
    CrossrefPubMedSearch in Google Scholar
  • 10 Stein PD, Beemath A, Meyers FA, Skaf E, Sanchez J, Olson RE. Incidence of venous thromboembolism in patients hospitalized with cancer. Am J Med 2006; 119 (01) 60-68
    CrossrefPubMedSearch in Google Scholar
  • 11 Fernandes CJCDS. Evolution in the management of non-small cell lung cancer in Brazil. J Bras Pneumol 2017; 43 (06) 403-404
    CrossrefPubMedSearch in Google Scholar
  • 12 Gade IL, Braekkan SK, Naess IA. et al. The impact of initial cancer stage on the incidence of venous thromboembolism: the Scandinavian Thrombosis and Cancer (STAC) Cohort. J Thromb Haemost 2017; 15 (08) 1567-1575
    CrossrefPubMedSearch in Google Scholar
  • 13 Connolly GC, Francis CW. Cancer-associated thrombosis. Hematology (Am Soc Hematol Educ Program) 2013; 2013: 684-691
    CrossrefPubMedSearch in Google Scholar
  • 14 Farge D, Bounameaux H, Brenner B. et al. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 2016; 17 (10) e452-e466
    CrossrefPubMedSearch in Google Scholar
  • 15 Farge D, Frere C, Connors JM. et al; International Initiative on Thrombosis and Cancer (ITAC) advisory panel. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 2019; 20 (10) e566-e581
    CrossrefPubMedSearch in Google Scholar
  • 16 Key NS, Khorana AA, Kuderer NM. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 2020; 38 (05) 496-520
    CrossrefPubMedSearch in Google Scholar
  • 17 Moik F, Posch F, Zielinski C, Pabinger I, Ay C. Direct oral anticoagulants compared to low-molecular-weight heparin for the treatment of cancer-associated thrombosis: updated systematic review and meta-analysis of randomized controlled trials. Res Pract Thromb Haemost 2020; 4 (04) 550-561
    CrossrefPubMedSearch in Google Scholar
  • 18 Agnelli G, Becattini C, Bauersachs R. et al; Caravaggio Study Investigators. Apixaban versus dalteparin for the treatment of acute venous thromboembolism in patients with cancer: The Caravaggio Study. Thromb Haemost 2018; 118 (09) 1668-1678
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Agnelli G, Becattini C, Meyer G. et al; Caravaggio Investigators. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med 2020; 382 (17) 1599-1607
    CrossrefPubMedSearch in Google Scholar
  • 20 McBane II RD, Wysokinski WE, Le-Rademacher JG. et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: the ADAM VTE trial. J Thromb Haemost 2020; 18 (02) 411-421
    CrossrefPubMedSearch in Google Scholar
  • 21 Raskob GE, van Es N, Verhamme P. et al; Hokusai VTE Cancer Investigators. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 2018; 378 (07) 615-624
    CrossrefPubMedSearch in Google Scholar
  • 22 Young AM, Marshall A, Thirlwall J. et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol 2018; 36 (20) 2017-2023
    CrossrefPubMedSearch in Google Scholar
  • 23 Shaw JR, Douketis J, Le Gal G, Carrier M. Periprocedural interruption of anticoagulation in patients with cancer-associated venous thromboembolism: An analysis of thrombotic and bleeding outcomes. J Thromb Haemost 2019; 17 (07) 1171-1178
    CrossrefPubMedSearch in Google Scholar
  • 24 Carrier M, Blais N, Crowther M. et al. Treatment algorithm in cancer-associated thrombosis: Canadian expert consensus. Curr Oncol 2018; 25 (05) 329-337
    CrossrefPubMedSearch in Google Scholar
  • 25 Cohen AT, Katholing A, Rietbrock S, Bamber L, Martinez C. Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A population-based cohort study. Thromb Haemost 2017; 117 (01) 57-65
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Lloyd AJ, Dewilde S, Noble S, Reimer E, Lee AYY. What impact does venous thromboembolism and bleeding have on cancer patients' quality of life?. Value Health 2018; 21 (04) 449-455
    CrossrefPubMedSearch in Google Scholar
  • 27 Fernandes CJ, Morinaga LTK, Alves Jr JL. et al. Cancer-associated thrombosis: the when, how and why. Eur Respir Rev 2019; 28 (151) 180119
    CrossrefPubMedSearch in Google Scholar
  • 28 Lee AY, Levine MN, Baker RI. et al; Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349 (02) 146-153
    CrossrefPubMedSearch in Google Scholar
  • 29 Lee AYY, Kamphuisen PW, Meyer G. et al; CATCH Investigators. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: a randomized clinical trial. JAMA 2015; 314 (07) 677-686
    CrossrefPubMedSearch in Google Scholar
  • 30 Meyer G, Marjanovic Z, Valcke J. et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 2002; 162 (15) 1729-1735
    CrossrefPubMedSearch in Google Scholar
  • 31 Deitcher SR, Kessler CM, Merli G, Rigas JR, Lyons RM, Fareed J. ONCENOX Investigators. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost 2006; 12 (04) 389-396
    CrossrefPubMedSearch in Google Scholar
  • 32 Akl EA, Kahale L, Barba M. et al. Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer. Cochrane Database Syst Rev 2014; (07) CD006650
    PubMedSearch in Google Scholar
  • 33 Hakoum MB, Kahale LA, Tsolakian IG. et al. Anticoagulation for the initial treatment of venous thromboembolism in people with cancer. Cochrane Database Syst Rev 2018; 1: CD006649
    PubMedSearch in Google Scholar
  • 34 Posch F, Königsbrügge O, Zielinski C, Pabinger I, Ay C. Treatment of venous thromboembolism in patients with cancer: A network meta-analysis comparing efficacy and safety of anticoagulants. Thromb Res 2015; 136 (03) 582-589
    CrossrefPubMedSearch in Google Scholar
  • 35 Vedovati MC, Germini F, Agnelli G, Becattini C. Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis. Chest 2015; 147 (02) 475-483
    CrossrefPubMedSearch in Google Scholar
  • 36 Mahé I, Elalamy I, Gerotziafas GT, Girard P. Treatment of cancer-associated thrombosis: beyond HOKUSAI. TH Open 2019; 3 (03) e309-e315
    Thieme ConnectPubMedSearch in Google Scholar
  • 37 FRAGMIN. Dalteparin sodium: Highlights of prescribing information. 2019 . Accessed June 1, 2021 at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020287s072lbl.pdf
    PubMedSearch in Google Scholar
  • 38 Fragmin® 5000 IU. Summary of product characteristics. 2020 https://www.medicines.org.uk/emc/medicine/26896#gref . Accessed June 1, 2021
    PubMedSearch in Google Scholar
  • 39 van Es N, Di Nisio M, Bleker SM. et al. Edoxaban for treatment of venous thromboembolism in patients with cancer. Rationale and design of the Hokusai VTE-cancer study. Thromb Haemost 2015; 114 (06) 1268-1276
    Thieme ConnectPubMedSearch in Google Scholar
  • 40 Giustozzi M, Agnelli G, Del Toro-Cervera J. et al. Direct oral anticoagulants for the treatment of acute venous thromboembolism associated with cancer: a systematic review and meta-analysis. Thromb Haemost 2020; 120 (07) 1128-1136
    Thieme ConnectPubMedSearch in Google Scholar
  • 41 Sabatino J, De Rosa S, Polimeni A, Sorrentino S, Indolfi C. Direct oral anticoagulants in patients with active cancer: a systematic review and meta-analysis. JACC: CardioOncology. 2020; 2 (03) 428-440
    CrossrefPubMedSearch in Google Scholar
  • 42 Meyer G, Planquette B. Incidental venous thromboembolism, detected by chance, but still venous thromboembolism. Eur Respir J 2020; 55 (02) 2000028
    CrossrefPubMedSearch in Google Scholar
  • 43 Kopolovic I, Lee AY, Wu C. Management and outcomes of cancer-associated venous thromboembolism in patients with concomitant thrombocytopenia: a retrospective cohort study. Ann Hematol 2015; 94 (02) 329-336
    CrossrefPubMedSearch in Google Scholar
  • 44 Francis CW, Kessler CM, Goldhaber SZ. et al. Treatment of venous thromboembolism in cancer patients with dalteparin for up to 12 months: the DALTECAN Study. J Thromb Haemost 2015; 13 (06) 1028-1035
    CrossrefPubMedSearch in Google Scholar
  • 45 Jara-Palomares L, Solier-Lopez A, Elias-Hernandez T. et al. Tinzaparin in cancer associated thrombosis beyond 6months: TiCAT study. Thromb Res 2017; 157: 90-96
    CrossrefPubMedSearch in Google Scholar
  • 46 Di Nisio M, van Es N, Carrier M. et al. Extended treatment with edoxaban in cancer patients with venous thromboembolism: a post-hoc analysis of the Hokusai-VTE Cancer study. J Thromb Haemost 2019; 17 (11) 1866-1874
    CrossrefPubMedSearch in Google Scholar
  • 47 Marshall A, Levine M, Hill C. et al. Treatment of cancer-associated venous thromboembolism: 12-month outcomes of the placebo versus rivaroxaban randomization of the SELECT-D Trial (SELECT-D: 12m). J Thromb Haemost 2020; 18 (04) 905-915
    CrossrefPubMedSearch in Google Scholar
  • 48 ClinicalTrials.gov. API-CAT STUDY for APIxaban Cancer Associated Thrombosis (API-CAT). 2019 . Accessed July 25, 2020 at: https://clinicaltrials.gov/ct2/show/NCT03692065
    PubMedSearch in Google Scholar
  • 49 Fidelman N. Update on treatment of cancer-associated thrombosis. Endovasc Today 2019; 18 (10) 104-112
    PubMedSearch in Google Scholar
  • 50 Samuelson Bannow BT, Lee A, Khorana AA. et al. Management of cancer-associated thrombosis in patients with thrombocytopenia: guidance from the SSC of the ISTH. J Thromb Haemost 2018; 16 (06) 1246-1249
    CrossrefPubMedSearch in Google Scholar
  • 51 Prandoni P, Lensing AW, Piccioli A. et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100 (10) 3484-3488
    CrossrefPubMedSearch in Google Scholar
  • 52 Registry RIETE. . Accessed June 1, 2021 at: https://rieteregistry.com/
    PubMed
  • 53 Chee CE, Ashrani AA, Marks RS. et al. Predictors of venous thromboembolism recurrence and bleeding among active cancer patients: a population-based cohort study. Blood 2014; 123 (25) 3972-3978
    CrossrefPubMedSearch in Google Scholar
  • 54 Louzada ML, Majeed H, Dao V, Wells PS. Risk of recurrent venous thromboembolism according to malignancy characteristics in patients with cancer-associated thrombosis: a systematic review of observational and intervention studies. Blood Coagul Fibrinolysis 2011; 22 (02) 86-91
    CrossrefPubMedSearch in Google Scholar
  • 55 Trujillo-Santos J, Nieto JA, Tiberio G. et al; RIETE Registry. Predicting recurrences or major bleeding in cancer patients with venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost 2008; 100 (03) 435-439
    Thieme ConnectPubMedSearch in Google Scholar
  • 56 Louzada ML, Carrier M, Lazo-Langner A. et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation 2012; 126 (04) 448-454
    CrossrefPubMedSearch in Google Scholar
  • 57 Girard P, Laporte S, Chapelle C. et al. Failure of the Ottawa Score to predict the risk of recurrent venous thromboembolism in cancer patients: the prospective PREDICARE cohort study. Thromb Haemost 2021; (e-pub ahead of print)
    Thieme ConnectPubMedSearch in Google Scholar
  • 58 Mulder FI, Bosch FTM, Young AM. et al. Direct oral anticoagulants for cancer-associated venous thromboembolism: a systematic review and meta-analysis. Blood 2020; 136 (12) 1433-1441
    CrossrefPubMedSearch in Google Scholar
  • 59 Luk C, Wells PS, Anderson D, Kovacs MJ. Extended outpatient therapy with low molecular weight heparin for the treatment of recurrent venous thromboembolism despite warfarin therapy. Am J Med 2001; 111 (04) 270-273
    CrossrefPubMedSearch in Google Scholar
  • 60 Carrier M, Le Gal G, Cho R, Tierney S, Rodger M, Lee AY. Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients. J Thromb Haemost 2009; 7 (05) 760-765
    CrossrefPubMedSearch in Google Scholar
  • 61 Ihaddadene R, Le Gal G, Delluc A, Carrier M. Dose escalation of low molecular weight heparin in patients with recurrent cancer-associated thrombosis. Thromb Res 2014; 134 (01) 93-95
    CrossrefPubMedSearch in Google Scholar
  • 62 Schulman S, Zondag M, Linkins L. et al. Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis. J Thromb Haemost 2015; 13 (06) 1010-1018
    CrossrefPubMedSearch in Google Scholar
  • 63 Mosarla RC, Vaduganathan M, Qamar A, Moslehi J, Piazza G, Giugliano RP. Anticoagulation strategies in patients with cancer: JACC review topic of the week. J Am Coll Cardiol 2019; 73 (11) 1336-1349
    CrossrefPubMedSearch in Google Scholar
  • 64 Gelosa P, Castiglioni L, Tenconi M. et al. Pharmacokinetic drug interactions of the non-vitamin K antagonist oral anticoagulants (NOACs). Pharmacol Res 2018; 135: 60-79
    CrossrefPubMedSearch in Google Scholar
  • 65 Riess H, Prandoni P, Harder S, Kreher S, Bauersachs R. Direct oral anticoagulants for the treatment of venous thromboembolism in cancer patients: potential for drug-drug interactions. Crit Rev Oncol Hematol 2018; 132: 169-179
    CrossrefPubMedSearch in Google Scholar
  • 66 Hanigan S, Das J, Pogue K, Barnes GD, Dorsch MP. The real world use of combined P-glycoprotein and moderate CYP3A4 inhibitors with rivaroxaban or apixaban increases bleeding. J Thromb Thrombolysis 2020; 49 (04) 636-643
    CrossrefPubMedSearch in Google Scholar
  • 67 Hill K, Sucha E, Rhodes E. et al. Risk of hospitalization with hemorrhage among older adults taking clarithromycin vs azithromycin and direct oral anticoagulants. JAMA Intern Med 2020; 180 (08) 1052-1060
    CrossrefPubMedSearch in Google Scholar
  • 68 Short NJ, Connors JM. New oral anticoagulants and the cancer patient. Oncologist 2014; 19 (01) 82-93
    CrossrefPubMedSearch in Google Scholar
  • 69 Verso M, Munoz A, Bauersachs R. et al. Effects of concomitant administration of anticancer agents and apixaban or dalteparin on recurrence and bleeding in patients with cancer-associated venous thromboembolism. Eur J Cancer 2021; 148: 371-381
    CrossrefPubMedSearch in Google Scholar
  • 70 Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006; 166 (04) 458-464
    CrossrefPubMedSearch in Google Scholar
  • 71 Petterson TM, Marks RS, Ashrani AA, Bailey KR, Heit JA. Risk of site-specific cancer in incident venous thromboembolism: a population-based study. Thromb Res 2015; 135 (03) 472-478
    CrossrefPubMedSearch in Google Scholar
  • 72 Wun T, White RH. Venous thromboembolism (VTE) in patients with cancer: epidemiology and risk factors. Cancer Invest 2009; 27 (Suppl. 01) 63-74
    CrossrefPubMedSearch in Google Scholar
  • 73 Riess H, Habbel P, Jühling A, Sinn M, Pelzer U. Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers - Review. World J Gastrointest Oncol 2016; 8 (03) 258-270
    CrossrefPubMedSearch in Google Scholar
  • 74 Gerber DE, Grossman SA, Streiff MB. Management of venous thromboembolism in patients with primary and metastatic brain tumors. J Clin Oncol 2006; 24 (08) 1310-1318
    CrossrefPubMedSearch in Google Scholar
  • 75 Weinstock MJ, Uhlmann EJ, Zwicker JI. Intracranial hemorrhage in cancer patients treated with anticoagulation. Thromb Res 2016; 140 (Suppl. 01) S60-S65
    CrossrefPubMedSearch in Google Scholar
  • 76 Riedl J, Ay C. Venous thromboembolism in brain tumors: risk factors, molecular mechanisms, and clinical challenges. Semin Thromb Hemost 2019; 45 (04) 334-341
    Thieme ConnectPubMedSearch in Google Scholar
  • 77 Carney BJ, Uhlmann EJ, Puligandla M. et al. Intracranial hemorrhage with direct oral anticoagulants in patients with brain tumors. J Thromb Haemost 2019; 17 (01) 72-76
    CrossrefPubMedSearch in Google Scholar
  • 78 Leader A, Hamulyák EN, Carney BJ. et al. Intracranial hemorrhage with direct oral anticoagulants in patients with brain metastases. Blood Adv 2020; 4 (24) 6291-6297
    CrossrefPubMedSearch in Google Scholar
  • 79 Chong BH, Lee SH. Management of thromboembolism in hematologic malignancies. Semin Thromb Hemost 2007; 33 (04) 435-448
    Thieme ConnectPubMedSearch in Google Scholar
  • 80 Yentz S, Onwuemene OA, Stein BL, Cull EH, McMahon B. Clinical use of anti-Xa monitoring in malignancy-associated thrombosis. Thrombosis 2015; 2015: 126975
    CrossrefPubMedSearch in Google Scholar