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Venous Thromboembolism Treatment and Prevention in Cancer Patients: Can We Use Pills Yet?

  • Gynecologic Cancers (LA Cantrell, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Cancer increases a patient’s risk for developing a venous thromboembolism (VTE) and is a relatively common finding in this population. Traditionally, anticoagulants used to treat VTE have included low molecular weight heparin (LMWH) or vitamin K antagonists (VKA). However, within the last several years, a newer class of anticoagulant, the direct oral anticoagulants (DOACs), has emerged as a potential option for pharmacologic thromboprophylaxis and for treatment of VTE in patients with cancer. While data is still limited and evolving, DOACs offer several benefits that are worth considering, including ease of administration and similar efficacy compared to LMWH in preventing recurrent VTE. However, some studies have reported a notable risk of increased bleeding associated with the use of DOACs. Additional studies are underway to evaluate the role of DOACs compared to LMWH in the setting of cancer. In our practice, based on existing data, we have been using DOACs for the chronic treatment of acute VTE and prevention of recurrent VTE in patients who do not have contraindications to anticoagulation and do not have severe renal insufficiency (creatinine clearance < 30 mL/min). For cancer patients admitted to the hospital with an acute medical illness, we use LMWH for primary prevention of VTE. In the perioperative setting, for patients undergoing major surgery with an active cancer, we prefer pharmacologic thromboprophylaxis with LMWH, although there is some emerging evidence that DOACs may be safe in this setting.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Carilion Clinic, 1906 Belleview Ave Se, Roanoke, VA, 24016, USA

    Tulsi Patel MD

  2. Division of Gynecologic Oncology, Carilion Clinic, 1 Riverside Circle, Suite 300, Roanoke, VA, 24016, USA

    David A. Iglesias MD, MS

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Correspondence to David A. Iglesias MD, MS.

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Patel, T., Iglesias, D.A. Venous Thromboembolism Treatment and Prevention in Cancer Patients: Can We Use Pills Yet?. Curr. Treat. Options in Oncol. 21, 43 (2020). https://doi.org/10.1007/s11864-020-00744-w

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