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Hamostaseologie
DOI: 10.1055/a-2431-6818
Original Article

Challenging Situations in the Treatment of Cancer-Associated Thrombosis

Ekaterina Balaian
1   Medical Department I, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
2   German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
,
Sandra Marten
1   Medical Department I, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
,
Jan Beyer-Westendorf
1   Medical Department I, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
,
Karolin Trautmann-Grill
1   Medical Department I, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
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Abstract

Cancer-associated thrombosis (CAT) is a common clinical problem in the treatment of cancer patients posing some unique challenges. These include the need to balance between the risk of recurrent thromboembolic events and bleeding complications in the individual cancer patient. A frequently encountered dilemma is the need for long-term anticoagulation in the setting of active malignancy. Until now, optimal duration, intensity, and type of anticoagulation in cancer patients remain an area of ongoing debate. In this case-based review, we present several challenging clinical scenarios and provide guidance on management. For optimal treatment results, CAT generally requires a multidisciplinary approach including specialists for thrombosis and hemostasis as well as hematology and oncology. Individual patient preferences should always be taken into account, especially in clinical situations with weak treatment evidence.

Zusammenfassung

Die Tumor-assoziierte Thrombose ist ein häufiges klinisches Problem bei Krebspa-tient*innen und gekennzeichnet durch spezifische Behandlungsherausforderungen. Dazu gehört vor allem die schwierige Abwägung des individuellen Thrombose- und Blutungsrisikos. Ein ständiges Dilemma ist die Notwendigkeit der Langzeitantikoagulation bei aktiver Krebserkrankung. Bis heute sind die optimale Dauer, Intensität und Art der Antikoagulation bei Krebspatient*innen umstritten.

In dieser fallbasierten Übersichtsarbeit gehen wir auf schwierige klinische Situationen ein und präsentieren mögliche Lösungsansätze. Für ein optimales Ergebnis sollte die Behandlung der Tumor-assoziierte Thrombose stets multidisziplinär erfolgen beziehungsweise nach Abstimmung zwischen Hämostaseologen und Hämatoonkologen. Ebenso wichtig ist die Berücksichtigung der individuellen Patientenpräferenz insbesondere in klinischen Situationen mit schlechter Evidenzlage.

Keywords

cancer - thrombosis - anticoagulation

Schlüsselwörter

Krebs - Thrombose - Antikoagulation

Authors' Contributions

E.B. was involved in patient treatment and wrote the manuscript; S.M., J.B-W., and K.T-G. were involved in patient treatment, revised the manuscript, and approved the final version for publication.


Competing Interests

E.B. received travel compensation from Novartis. S.M. received honoraria and institutional research support from Bayer AG, Daiichi Sankyo, Pfizer, Swedish Orphan Biovitrum GmbH, Bristol-Myers Squibb, and Biotest AG. J.B-W. received honoraria and institutional research support from Alexion/AstraZeneca, Bayer AG, Boehringer Ingelheim, Daiichi Sankyo, Bristol-Myers Squibb, Leo Pharma, Mitsubishi Pharma, Norgine, and Pfizer. K.T-G. received consulting fees from Takeda, Roche, Grifols, and SOBI; honoraria from Amgen, Roche, Sanofi, SOBI, Grifols, Novartis, and Pfizer; and travel support from Grifols and Takeda.




Publication History

Received: 24 April 2024

Accepted: 08 October 2024

Article published online:
04 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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