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Hamostaseologie 2020; 40(01): 038-046
DOI: 10.1055/s-0039-3402806
Review Article
Georg Thieme Verlag KG Stuttgart · New York

How I Manage Cancer-Associated Thrombosis

Management der Krebs-assoziierten Thrombose
Florian Moik
1   Clinical Division of Haematology and Haemostaseology, Department of Internal Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
,
Cihan Ay
1   Clinical Division of Haematology and Haemostaseology, Department of Internal Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
2   I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
› Author Affiliations
Further Information

Publication History

25 August 2019

04 November 2019

Publication Date:
27 January 2020 (online)

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Abstract

In this concise review, we discuss some common clinical challenges in the management of patients with cancer-associated venous thromboembolism (VTE), a frequent complication in patients with cancer that increases morbidity and mortality. While direct oral anticoagulants (DOACs) have been established in clinical practice for anticoagulation in patients with VTE without cancer, their efficacy and safety in patients with cancer have not been assessed in randomized controlled trials until recently. The choice of the appropriate anticoagulant agent in the era of DOACs to treat patients with cancer-associated VTE is based on balancing the risk of recurrence against the risk of bleeding, and potential drug–drug interactions. However, the management of patients is challenged by special scenarios such as incidentally diagnosed pulmonary embolism and catheter-related thrombosis, and sometimes complicated by concomitant thrombocytopenia. We provide guidance for management of cancer-associated VTE in different clinical scenarios in a case-based manner and briefly review recent clinical studies and guidelines to explain our approach to management of the cases.

Zusammenfassung

Im Rahmen dieser Übersichtsarbeit werden einige Facetten und Herausforderungen beleuchtet, die die Behandlung von PatientInnen mit Krebs-assoziierten venösen Thromboembolien (VTE) mit sich bringt. Während für die Behandlung der VTE bei PatientInnen ohne Krebs direkte orale Antikoagulanzien (DOAK) bereits ihren Einzug in die klinische Routine gefunden haben, waren Effektivität und Sicherheit dieser Medikament Therapie der Krebs-assoziierten VTE bis kürzlich nicht durch ausreichende Evidenz gesichert. Verkompliziert wird Antikoagulation bei Personen mit einer Krebserkrankung durch ein erhöhtes VTE-Rezidiv- und Blutungsrisiko, potentielle Medikamenteninteraktionen, eine begleitende Thrombozytopenie sowie spezielle klinische Fälle wie die Katheter-assoziierten Thrombose oder eine inzidentell diagnostizierte Pulmonalembolie. Das Ziel dieser Arbeit ist es, die neueste Evidenz zu den klinischen Herausforderungen einer Krebs-assoziierten VTE Fall-basiert zusammenzufassen und damit einen Leitfaden für den klinischen Alltag zu bieten.

Keywords

cancer - thrombosis - venous thromboembolism - anticoagulation - DOAC

Schlüsselwörter

Krebs - Thrombose - venöse Thromboembolie - Antikoagulation - DOAK
 

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