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Review
. 2023 Sep;25(9):979-987.
doi: 10.1007/s11912-023-01428-y. Epub 2023 Jun 6.

Direct Oral Anticoagulants for Cancer-Associated Venous Thromboembolism

Marta Masini  1 , Matteo Toma #  2 , Paolo Spallarossa  2 , Italo Porto  1   2 , Pietro Ameri  3   4
Affiliations
Review

Direct Oral Anticoagulants for Cancer-Associated Venous Thromboembolism

Marta Masini et al. Curr Oncol Rep. 2023 Sep.

Abstract

Purpose of review: To present the randomized controlled trial (RCT) evidence and highlight the areas of uncertainty regarding direct oral anticoagulants (DOAC) for cancer-associated venous thromboembolism (CAT).

Recent findings: In the last years, four RCTs have shown that rivaroxaban, edoxaban, and apixaban are at least as effective as low-molecular-weight heparin (LMWH) for the treatment of both incidental and symptomatic CAT. On the other hand, these drugs increase the risk of major gastrointestinal bleeding in patients with cancer at this site. Another two RCTs have demonstrated that apixaban and rivaroxaban also prevent CAT in subjects at intermediate-to-high risk commencing chemotherapy, albeit at the price of higher likelihood of bleeding. By contrast, data are limited about the use DOAC in individuals with intracranial tumors or concomitant thrombocytopenia. It is also possible that some anticancer agents heighten the effects of DOAC via pharmacokinetic interactions, up to making their effectiveness-safety profile unfavorable. Leveraging the results of the aforementioned RCTS, current guidelines recommend DOAC as the anticoagulants of choice for CAT treatment and, in selected cases, prevention. However, the benefit of DOAC is less defined in specific patient subgroups, in which the choice of DOAC over LMWH should be carefully pondered.

Keywords: Anticoagulation; Cancer; Cardio-oncology; Embolism; Thrombosis.

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Conflict of interest statement

P. S. received speaker and/or advisor fees from Daiichi Sankyo, Bayer, Incyte, Gentili, FIRMA, and Malesci, all outside the submitted work.

I. P. received speaker and/or advisor fees from AstraZeneca, Daiichi Sankyo, Terumo Corporation, Biotronik, Bayer, and Amgen, all outside the submitted work.

P. A. received speaker and/or advisor fees from Daiichi Sankyo, AstraZeneca, Boehringer Ingelheim, Bayer, Novartis, Vifor, Janssen, and MSD, all outside the submitted work.

Figures

Fig. 1
Fig. 1
Therapeutic anticoagulation schemas for the treatment of cancer-associated venous thromboembolism. b.i.d., bis in die; eGFR, estimated glomerular filtration rate, as calculated by the Cockcroft-Gault formula; LMWH, low-molecular-weight heparin; P-gp, P glycoprotein; q.d., quaque die; UFH, unfractionated heparin
See this image and copyright information in PMC

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