Current Oncology Reports

, 21:18 | Cite as

Anticoagulation in Cancer Patients: a Summary of Pitfalls to Avoid

  • Harsh K. Patel
  • Alok A. KhoranaEmail author
Palliative Medicine (A Jatoi, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Palliative Medicine


Purpose of Review

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients, and its management is often associated with complications including risk of recurrent VTE and bleeding. Here, we review the current data on pitfalls during anticoagulation in cancer patients and measures necessary to avoid them.

Recent Findings

Although low-molecular-weight heparin monotherapy has been the standard of treatment for several years, emerging data for direct oral anticoagulants (DOACs) are leading to new paradigms in treatment. Reports of recent randomized trials suggest a lower risk of recurrent thrombosis but higher risk of bleeding, particularly in gastrointestinal cancer patients, with DOACs. Careful patient selection and individualization of therapy based on risk of bleeding as well as recurrent VTE are keys.


Problems like bleeding, recurrence, thrombocytopenia, drug-drug interactions, renal impairment, nausea-vomiting along with concerns about adherence arise during anticoagulation in cancer patients. However, with adequate pre-treatment assessment, correct anticoagulant selection and proper monitoring during anticoagulation, these issues can be addressed safely and effectively.


Cancer VTE Thromboembolism Anticoagulation Thromboprophylaxis Pitfalls Bleeding Thrombocytopenia Chemotherapy LMWH VKA DOAC Adherence Renal insufficiency Drug-drug interactions 


Compliance with Ethical Standards

Conflict of Interest

Harsh K. Patel declares that he has no conflict of interest.

Alok A. Khorana has received compensation from Bayer, Sanofi, Parexel, Halozyme Therapeutics, Pfizer, Seattle Genetics, Pharmacyclics, PharmaCyte Biotech, AngioDynamics, LEO Pharma, TriSalus, and Medscape/WebMD for service as a consultant; has received travel support from Bayer, Sanofi, Parexel, Janssen, Halozyme Therapeutics, Pfizer, Seattle Genetics, AngioDynamics, LEO Pharma, and Medscape/WebMD; and is the Co-Chair of the CASSINI Steering Committee, as well as the National Coordinator for the MARINER trial, both of which are funded by Janssen.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines)


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Kansas City VA Medical CenterKansas CityUSA
  2. 2.Taussig Cancer Institute, Cleveland ClinicClevelandUSA

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