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The Role of New Oral Anticoagulants (NOACs) in Cancer Patients

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Thrombosis and Embolism: from Research to Clinical Practice

Part of the book series: Advances in Experimental Medicine and Biology ((AIM,volume 906))

Abstract

New oral anticoagulants (NOACs) are likely to have a major impact in the next few years, changing clinical practice of anticoagulation therapy. Evidence on its efficacy and superiority to vitamin K antagonists (VKAs) in treating non-cancer patients have been reported in a few clinical trials. However, patients with cancer are complicated by the prothrombotic nature of the disease, need for potentially invasive surgery and interventions, and altered drug handling. This chapter examines the available evidence and guidelines on the use of NOAC in patients with cancer.

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References

  • Agnelli G, Buller HR, Cohen A et al (2013a) Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369:799–808

    Article  CAS  PubMed  Google Scholar 

  • Agnelli G, Buller HR, Cohen A et al (2013b) Apixaban for extended treatment of venous thromboembolism. N Engl J Med 368:699–708

    Article  CAS  PubMed  Google Scholar 

  • Akl EA, Terrenato I, Barba M, Sperati F, Muti P, Schunemann HJ (2008) Extended perioperative thromboprophylaxis in patients with cancer. A systematic review. Thromb Haemost 100:1176–1180

    CAS  PubMed  Google Scholar 

  • Akl EA, Labedi N, Barba M et al (2011a) Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer. Cochrane Database Syst Rev 7:CD006650

    Google Scholar 

  • Akl EA, Vasireddi SR, Gunukula S et al (2011b) Anticoagulation for patients with cancer and central venous catheters. Cochrane Database Syst Rev 2:CD006468

    Google Scholar 

  • Bauersachs R, Berkowitz SD et al (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363:2499–2510

    Article  CAS  PubMed  Google Scholar 

  • Bergqvist D, Agnelli G, Cohen AT et al (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346:975–980

    Article  CAS  PubMed  Google Scholar 

  • Blom JW, Doggen CJ, Osanto S, Rosendaal FR (2005) Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 293:715–722

    Article  CAS  PubMed  Google Scholar 

  • Blom JW, Vanderschoot JP, Oostindier MJ, Osanto S, van der Meer FJ, Rosendaal FR (2006) Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost 4:529–535

    Article  CAS  PubMed  Google Scholar 

  • Buller HR, Prins MH et al (2012) Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 366:1287–1297

    Article  PubMed  Google Scholar 

  • Cabral KP (2013) Pharmacology of the new target-specific oral anticoagulants. J Thromb Thrombolysis 36:133–140

    Article  CAS  PubMed  Google Scholar 

  • Caine GJ, Stonelake PS, Lip GY, Kehoe ST (2002) The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia 4:465–473

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Carrier M, Le Gal G, Wells PS, Fergusson D, Ramsay T, Rodger MA (2008) Systematic review: the Trousseau syndrome revisited: should we screen extensively for cancer in patients with venous thromboembolism? Ann Intern Med 149:323–333

    Article  PubMed  Google Scholar 

  • Clagett GP, Reisch JS (1988) Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg 208:227–240

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cohen AT, Spiro TE, Buller HR et al (2011) Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol. J Thromb Thrombolysis 31:407–416

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cronin-Fenton DP, Sondergaard F, Pedersen LA et al (2010) Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in Denmark, 1997–2006. Br J Cancer 103:947–953

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Di Nisio M, Porreca E, Ferrante N, Otten HM, Cuccurullo F, Rutjes AW (2012) Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy. Cochrane Database Syst Rev 2:CD008500

    Google Scholar 

  • Elyamany G, Alzahrani AM, Bukhary E (2014) Cancer-associated thrombosis: an overview. Clin Med Insights Oncol 8:129–137

    Article  PubMed  PubMed Central  Google Scholar 

  • Eriksson BI, Quinlan DJ, Weitz JI (2009) Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor xa inhibitors in development. Clin Pharmacokinet 48:1–22

    Article  CAS  PubMed  Google Scholar 

  • Farge D, Debourdeau P, Beckers M et al (2013) International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 11:56–70

    Article  CAS  PubMed  Google Scholar 

  • Goldhaber SZ, Leizorovicz A, Kakkar AK et al (2011) Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med 365:2167–2177

    Article  CAS  PubMed  Google Scholar 

  • Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd (2000) Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 160:809–815

    Article  CAS  PubMed  Google Scholar 

  • Hokusai VTEI, Buller HR, Decousus H et al (2013) Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 369:1406–1415

    Article  Google Scholar 

  • Horsted F, West J, Grainge MJ (2012) Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med 9:e1001275

    Article  PubMed  PubMed Central  Google Scholar 

  • Hutten BA, Prins MH, Gent M, Ginsberg J, Tijssen JG, Buller HR (2000) Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol Off J Am Soc Clin Oncol 18:3078–3083

    CAS  Google Scholar 

  • Kakkar AK, Haas S, Wolf H, Encke A (2005) Evaluation of perioperative fatal pulmonary embolism and death in cancer surgical patients: the MC-4 cancer substudy. Thromb Haemost 94:867–871

    CAS  PubMed  Google Scholar 

  • Kearon C, Akl EA, Comerota AJ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e419S–e494S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Khorana AA, Francis CW, Culakova E, Lyman GH (2005) Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study. Cancer 104:2822–2829

    Article  PubMed  Google Scholar 

  • Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH (2007) Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 5:632–634

    Article  CAS  PubMed  Google Scholar 

  • Kyriazi V, Theodoulou E (2013) Assessing the risk and prognosis of thrombotic complications in cancer patients. Arch Pathol Lab Med 137:1286–1295

    Article  PubMed  Google Scholar 

  • Lee AY, Levine MN, Baker RI et al (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349:146–153

    Article  CAS  PubMed  Google Scholar 

  • Levine MN, Gu C, Liebman HA et al (2012) A randomized phase II trial of apixaban for the prevention of thromboembolism in patients with metastatic cancer. J Thromb Haemost 10:807–814

    Article  CAS  PubMed  Google Scholar 

  • Levitan N, Dowlati A, Remick SC et al (1999) Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine 78:285–291

    Article  CAS  PubMed  Google Scholar 

  • Lyman GH, Khorana AA, Kuderer NM et al (2013a) Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol Off J Am Soc Clin Oncol 31:2189–2204

    Article  CAS  Google Scholar 

  • Lyman GH, Eckert L, Wang Y, Wang H, Cohen A (2013b) Venous thromboembolism risk in patients with cancer receiving chemotherapy: a real-world analysis. Oncologist 18:1321–1329

    Article  PubMed  PubMed Central  Google Scholar 

  • Mandala M, Falanga A, Roila F, Group EGW (2011) Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol Off J Eur Soc Med Oncol ESMO 22(Suppl 6):vi85–vi92

    Google Scholar 

  • Meyer G, Marjanovic Z, Valcke J et al (2002) Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 162:1729–1735

    Article  CAS  PubMed  Google Scholar 

  • NCCN (2014) NCCN guidelines. Version 2.2014 Venous Thromboembolic Disease. 2014.

    Google Scholar 

  • Prandoni P, Lensing AW, Piccioli A et al (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100:3484–3488

    Article  CAS  PubMed  Google Scholar 

  • Prandoni P, Carnovali M, Marchiori A, Galilei I (2004) Subcutaneous adjusted-dose unfractionated heparin vs fixed-dose low-molecular-weight heparin in the initial treatment of venous thromboembolism. Arch Intern Med 164:1077–1083

    Article  CAS  PubMed  Google Scholar 

  • Prandoni P, Falanga A, Piccioli A (2005) Cancer and venous thromboembolism. Lancet Oncol 6:401–410

    Article  PubMed  Google Scholar 

  • Prandoni P, Piovella C, Filippi L, Vedovetto V, Dalla Valle F, Piccioli A (2014) What are the pharmacotherapy options for treating venous thromboembolism in cancer patients? Expert Opin Pharmacother 15:799–807

    Article  CAS  PubMed  Google Scholar 

  • Schulman S, Kearon C, Kakkar AK et al (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361:2342–2352

    Article  CAS  PubMed  Google Scholar 

  • Schulman S, Kearon C, Kakkar AK et al (2013) Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med 368:709–718

    Article  CAS  PubMed  Google Scholar 

  • Schulman S, Kakkar AK, Goldhaber SZ et al (2014) Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 129:764–772

    Article  CAS  PubMed  Google Scholar 

  • Schulman S, Goldhaber SZ, Kearon C et al (2015) Treatment with dabigatran or warfarin in patients with venous thromboembolism and cancer. Thromb Haemost 113

    Google Scholar 

  • Siegal DM, Garcia D (2012) Anticoagulants in cancer. J Thromb Haemost 10:2230–2241

    Article  CAS  PubMed  Google Scholar 

  • Sorensen HT, Mellemkjaer L, Olsen JH, Baron JA (2000) Prognosis of cancers associated with venous thromboembolism. N Engl J Med 343:1846–1850

    Article  CAS  PubMed  Google Scholar 

  • Trousseau A (1865) Phlegmasia Alba Dolens. Clinique Medicale de l’Hotel-Dieu de Paris 3:654–712

    Google Scholar 

  • van Es N, Coppens M, Schulman S, Middeldorp S, Buller HR (2014) Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood 124:1968–1975

    Article  PubMed  Google Scholar 

  • Vedovati MC, Germini F, Agnelli G, Becattini C (2015) Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis. Chest 147:475–483

    Article  PubMed  Google Scholar 

  • Verso M, Agnelli G (2003) Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol Off J Am Soc Clin Oncol 21:3665–3675

    Article  Google Scholar 

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Authors and Affiliations

  1. Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Room 4N13C, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK

    Raveena Ravikumar

  2. Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK

    Chung Sim Lim & Alun Huw Davies

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  1. Raveena Ravikumar
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  2. Chung Sim Lim
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  3. Alun Huw Davies
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Correspondence to Raveena Ravikumar .

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Editors and Affiliations

  1. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden

    Md. Shahidul Islam

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Ravikumar, R., Lim, C.S., Davies, A.H. (2016). The Role of New Oral Anticoagulants (NOACs) in Cancer Patients. In: Islam, M. (eds) Thrombosis and Embolism: from Research to Clinical Practice. Advances in Experimental Medicine and Biology(), vol 906. Springer, Cham. https://doi.org/10.1007/5584_2016_112

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  • DOI: https://doi.org/10.1007/5584_2016_112

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22107-6

  • Online ISBN: 978-3-319-22108-3

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