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Review
. 2025 May 12;17(5):e83956.
doi: 10.7759/cureus.83956. eCollection 2025 May.

The Role of Direct Oral Anticoagulants (DOACs) in Cancer-Associated Thrombosis: A Comprehensive Review of the Literature

Muzammil R Qureshi  1 , Marian Barsoum  2 , Danyal Salim  3 , Sese Ekolle Mbonde Mudika  4 , Aly Barakat  5 , Neeraja Reghu Nair  6 , Tanzeela F Ahmed  7 , Shirish Nayyar  8 , Aya H Dahleh  9 , Sidra Ambreen  10 , Aamanda Noel  11 , Muteeba Fayyaz  12
Affiliations
Review

The Role of Direct Oral Anticoagulants (DOACs) in Cancer-Associated Thrombosis: A Comprehensive Review of the Literature

Muzammil R Qureshi et al. Cureus. .

Abstract

Venous thromboembolism (VTE) is a frequent and serious complication observed in patients with malignancy. The management of cancer-associated thrombosis (CAT) remains complex and multifactorial, influenced by cancer type, stage, comorbidities, and ongoing therapeutic regimens. Among anticoagulation strategies, direct oral anticoagulants (DOACs) have gained increasing attention as potential alternatives to low-molecular-weight heparins (LMWHs) in selected oncology populations. This narrative review evaluates the role of DOACs in the treatment of CAT, focusing on their clinical efficacy, safety considerations, and practical advantages, including oral administration and patient adherence. However, their use may be limited in certain cancer types and patients with renal or hepatic impairment. DOACs have also raised concerns regarding bleeding risks, drug interactions, and individualized dosing strategies. This review also highlights ongoing challenges such as optimal treatment duration, real-world applicability, and patient-specific considerations. The discussion aims to assess current data and clinical guidance while identifying future directions for integrating DOACs into standard oncology practice.

Keywords: anticoagulation in cancer; apixaban; bleeding risk in malignancy; cancer-associated thrombosis (cat); chemotherapy-induced thrombosis; direct oral anticoagulants (doacs); low-molecular-weight heparin (lmwh); rivaroxaban; thromboprophylaxis; venous thromboembolism (vte).

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Virchow's triad in cancer patients
Image Credit: Authors' original creation. This image was created using PowerPoint (Microsoft Corp., Redmond, WA, US).
Figure 2
Figure 2. Stepwise flowchart of the screening, inclusion, and exclusion processes for eligible studies
Figure 3
Figure 3. Patient-centered approach in anticoagulation of patients for cancer-associated thrombosis
Image Credit: Authors' original creation. This image was created using PowerPoint (Microsoft Corp., Redmond, WA, US).
See this image and copyright information in PMC

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