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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 
1   Department of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Monza, Italy
2   Department of Immunohematology and Transfusion Medicine, Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy
,
Grégoire Le Gal
3   Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
,
Marc Carrier
3   Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
,
Hikmat Abdel-Razeq
4   Department of Medicine, King Hussein Cancer Center, Amman, Jordan
,
Cihan Ay
5   Clinical Division of Haematology and Haemostaseology, Department of Internal Medicine, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
6   Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
,
Andrés J. Muñoz Martin
7   Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
,
Ana Thereza Cavalcanti Rocha
8   Departamento de Saúde da Família, Faculdade de Medicina da Bahia, Universidade Federal da Bahia – UFBA, Salvador, BA, Brazil
,
Giancarlo Agnelli
9   Internal Vascular and Emergency Medicine – Stroke Unit, University of Perugia, Perugia, Italy
,
Ismail Elalamy
6   Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
10   Hematology and Thrombosis Centre, Hôpital Tenon, INSERM U938, Sorbonne Université, AP-HP, Paris, France
,
Benjamin Brenner
6   Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
11   Department of Hematology, Rambam Health Care Campus, Haifa, Israel
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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

Disclosure

The content of the publication originated following a discussion at an advisory board meeting for which the authors received honoraria from Sanofi. However, the authors received no payment from Sanofi directly or indirectly (through a third party) related to the development/presentation of this publication.


Author Contributions

All authors were involved in the conception of the work, critically revising the manuscript, have provided the final approval, and take full accountability for the work, for all content and editorial decisions.




Publication History

Received: 26 February 2021

Accepted: 29 June 2021

Article published online:
31 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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