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

Anna Falanga; Grégoire Le Gal; Marc Carrier; Hikmat Abdel-Razeq; Cihan Ay; Andrés J. Muñoz Martin; Ana Thereza Cavalcanti Rocha; Giancarlo Agnelli; Ismail Elalamy; Benjamin Brenner

doi:10.1055/s-0041-1736037

TH Open, Table of Contents

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

¹Department of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Monza, Italy

²Department of Immunohematology and Transfusion Medicine, Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy

,

Grégoire Le Gal

³Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

,

Marc Carrier

³Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

,

Hikmat Abdel-Razeq

⁴Department of Medicine, King Hussein Cancer Center, Amman, Jordan

,

Cihan Ay

⁵Clinical Division of Haematology and Haemostaseology, Department of Internal Medicine, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria

⁶Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia

,

Andrés J. Muñoz Martin

⁷Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain

,

Ana Thereza Cavalcanti Rocha

⁸Departamento de Saúde da Família, Faculdade de Medicina da Bahia, Universidade Federal da Bahia – UFBA, Salvador, BA, Brazil

,

Giancarlo Agnelli

⁹Internal Vascular and Emergency Medicine – Stroke Unit, University of Perugia, Perugia, Italy

,

Ismail Elalamy

⁶Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia

¹⁰Hematology and Thrombosis Centre, Hôpital Tenon, INSERM U938, Sorbonne Université, AP-HP, Paris, France

,

Benjamin Brenner

⁶Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia

¹¹Department of Hematology, Rambam Health Care Campus, Haifa, Israel

› Author Affiliations

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

Full Text

References

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