Journal of Thrombosis and Thrombolysis

, Volume 47, Issue 3, pp 409–419 | Cite as

Evaluation of direct oral anticoagulants for the treatment of cancer-associated thrombosis: an update

  • A. Franco-MorenoEmail author
  • L. Cabezón-Gutiérrez
  • M. Palka-Kotlowsa
  • M. Villamayor-Delgado
  • M. García-Navarro


Cancer is associated with an increased risk of venous thromboembolism of four to sixfold. Cancer-related interventions such as chemotherapy, hormonal therapy and indwelling central venous catheters also increase the risk of venous thromboembolism. Low molecular weight heparin for at least 3–6 months is the current standard of care for the treatment of cancer associated venous thromboembolism. Anticoagulation should be continued as long as the cancer is active. Over the past few years, direct oral anticoagulants have emerged, including one direct thrombin inhibitor (dabigatran etexilate) and three factor Xa inhibitors (apixaban, edoxaban and rivaroxaban). In the randomized controlled trials comparing direct oral anticoagulants with vitamin K antagonists, the direct oral anticoagulants all provide non-inferior in prevention of thromboembolic events in patients with atrial fibrillation, for the prevention and treatment of venous thromboembolism and in acute coronary syndrome. In people with cancer, these drugs have emerged as attractive alternatives for the treatment of venous thromboembolism with the potential to overcome the limitations of low molecular weight heparin. Randomized controlled studies comparing direct oral anticoagulants to low molecular weight heparin in cancer patients are still limited and direct oral anticoagulants are not recommended for the treatment of cancer associated venous thromboembolism yet. However, new emerging data are supporting the use of direct oral anticoagulants in cancer-associated thrombosis. Here, we review recent data on the evidence related to the efficacy and safety of direct oral anticoagulants for the treatment of venous thromboembolism in patients with cancer.


Venous thromboembolism Cancer-associated thrombosis Anticoagulant therapy Direct oral anticoagulant Low molecular weight heparin Clinical trial 


Author contributions

All the authors have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results.

Compliance with ethical standards

Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineTorrejón University HospitalTorrejón de ArdozSpain
  2. 2.Department of Medical OncologyTorrejón University HospitalTorrejón de ArdozSpain

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