Direct oral anticoagulants in cancer-associated venous thromboembolism
This is a narrative review of the relevant literature on the epidemiology, pathogenesis, and treatment of venous thromboembolism (VTE) in cancer patients. In accordance with actual guidelines, the duration of anticoagulant therapy for cancer-associated venous thrombosis should be at least 6 months....
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Wolters Kluwer Medknow Publications
2020-01-01
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doaj-508d9147d3a642718398cc80a9bdeb3c2021-07-27T04:52:38ZengWolters Kluwer Medknow PublicationsVascular Investigation and Therapy2589-96862589-94812020-01-0132465310.4103/VIT.VIT_11_20Direct oral anticoagulants in cancer-associated venous thromboembolismKirill LobastovIlya SchastlivtsevIrina KanzafarovaThis is a narrative review of the relevant literature on the epidemiology, pathogenesis, and treatment of venous thromboembolism (VTE) in cancer patients. In accordance with actual guidelines, the duration of anticoagulant therapy for cancer-associated venous thrombosis should be at least 6 months. The use of Vitamin K antagonists (VKA) is associated with an increased risk of VTE recurrence and bleeding, so low-molecular-weight heparin (LMWH), in particular dalteparin, has been the “gold standard” until recently. Compared to VKA, prolonged use of LMWH can reduce the incidence of VTE recurrence without affecting the risk of bleeding or death. The main disadvantage of LMWH is low compliance, leading to premature discontinuation of treatment or switching to alternative anticoagulants. Direct oral anticoagulants (DOACs) have changed the situation. Compared to VKA, they demonstrated increased efficacy with similar or improved safety in patients with cancer-related VTE. Recently, the results of specialized studies comparing the use of DOACs to the use of dalteparin in cancer patients have been published: SELECT-D (rivaroxaban), HOKUSAI-VTE Cancer (edoxaban), ADAM VTE (apixaban), and CARAVAGGIO (apixaban). Rivaroxaban showed higher efficacy than dalteparin with a similar risk of major bleeding, but with an increased risk of clinically relevant nonmajor (CRNM) bleeding. Edoxaban had the same efficacy as dalteparin, though it showed an increased risk of major but not CRNM bleeding. Apixaban showed similar efficacy and safety as dalteparin in the CARAVAGGIO study, but did not provide higher safety in the ADAM VTE study. It was noted that gastrointestinal and urogenital bleeding dominated the structure of hemorrhagic complications of DOACs. The results of published trials are reflected in the current guidelines of the specialized societies. DOACs are recommended for VTE treatment in cancer patients.http://www.vitonline.org/article.asp?issn=2589-9686;year=2020;volume=3;issue=2;spage=46;epage=53;aulast=Lobastovdirect oral anticoagulantsmalignancypulmonary embolismvenous thromboembolismvenous thrombosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kirill Lobastov Ilya Schastlivtsev Irina Kanzafarova |
spellingShingle |
Kirill Lobastov Ilya Schastlivtsev Irina Kanzafarova Direct oral anticoagulants in cancer-associated venous thromboembolism Vascular Investigation and Therapy direct oral anticoagulants malignancy pulmonary embolism venous thromboembolism venous thrombosis |
author_facet |
Kirill Lobastov Ilya Schastlivtsev Irina Kanzafarova |
author_sort |
Kirill Lobastov |
title |
Direct oral anticoagulants in cancer-associated venous thromboembolism |
title_short |
Direct oral anticoagulants in cancer-associated venous thromboembolism |
title_full |
Direct oral anticoagulants in cancer-associated venous thromboembolism |
title_fullStr |
Direct oral anticoagulants in cancer-associated venous thromboembolism |
title_full_unstemmed |
Direct oral anticoagulants in cancer-associated venous thromboembolism |
title_sort |
direct oral anticoagulants in cancer-associated venous thromboembolism |
publisher |
Wolters Kluwer Medknow Publications |
series |
Vascular Investigation and Therapy |
issn |
2589-9686 2589-9481 |
publishDate |
2020-01-01 |
description |
This is a narrative review of the relevant literature on the epidemiology, pathogenesis, and treatment of venous thromboembolism (VTE) in cancer patients. In accordance with actual guidelines, the duration of anticoagulant therapy for cancer-associated venous thrombosis should be at least 6 months. The use of Vitamin K antagonists (VKA) is associated with an increased risk of VTE recurrence and bleeding, so low-molecular-weight heparin (LMWH), in particular dalteparin, has been the “gold standard” until recently. Compared to VKA, prolonged use of LMWH can reduce the incidence of VTE recurrence without affecting the risk of bleeding or death. The main disadvantage of LMWH is low compliance, leading to premature discontinuation of treatment or switching to alternative anticoagulants. Direct oral anticoagulants (DOACs) have changed the situation. Compared to VKA, they demonstrated increased efficacy with similar or improved safety in patients with cancer-related VTE. Recently, the results of specialized studies comparing the use of DOACs to the use of dalteparin in cancer patients have been published: SELECT-D (rivaroxaban), HOKUSAI-VTE Cancer (edoxaban), ADAM VTE (apixaban), and CARAVAGGIO (apixaban). Rivaroxaban showed higher efficacy than dalteparin with a similar risk of major bleeding, but with an increased risk of clinically relevant nonmajor (CRNM) bleeding. Edoxaban had the same efficacy as dalteparin, though it showed an increased risk of major but not CRNM bleeding. Apixaban showed similar efficacy and safety as dalteparin in the CARAVAGGIO study, but did not provide higher safety in the ADAM VTE study. It was noted that gastrointestinal and urogenital bleeding dominated the structure of hemorrhagic complications of DOACs. The results of published trials are reflected in the current guidelines of the specialized societies. DOACs are recommended for VTE treatment in cancer patients. |
topic |
direct oral anticoagulants malignancy pulmonary embolism venous thromboembolism venous thrombosis |
url |
http://www.vitonline.org/article.asp?issn=2589-9686;year=2020;volume=3;issue=2;spage=46;epage=53;aulast=Lobastov |
work_keys_str_mv |
AT kirilllobastov directoralanticoagulantsincancerassociatedvenousthromboembolism AT ilyaschastlivtsev directoralanticoagulantsincancerassociatedvenousthromboembolism AT irinakanzafarova directoralanticoagulantsincancerassociatedvenousthromboembolism |
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1721279834257096704 |