Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 4, pp 483–487 | Cite as

Evaluation of direct oral anticoagulants for the treatment of venous thromboembolism in the oncology population

  • Jessica HedvatEmail author
  • Christina Howlett
  • James McCloskey
  • Ruchi Patel


Direct oral anticoagulants (DOACs) have become an attractive option for the treatment of venous thromboembolism (VTE) in cancer patients. However, their use is currently not recommended as first-line treatment by national guidelines due to limited data in this patient population. The objective of this study was to evaluate the practice and safety patterns of DOACs when used for VTE treatment in the oncology population. This study was a retrospective chart review of adult cancer patients treated at Hackensack University Medical Center from January 2013 to October 2015 who received dabigatran, rivaroxaban, or apixaban for VTE treatment. Of 126 patients screened, 39 patients were included. Thirty-five patients received rivaroxaban and four patients received apixaban. Ten of 39 patients (26%) were not receiving a DOAC dosage consistent with the package insert. No patients experienced clinically significant bleeding, while four patients experienced a minor bleed. Four of 14 thrombocytopenic patients (29%) did not have their DOAC dose held for thrombocytopenia. All patients had their DOACs appropriately held for procedures. Increased education on dosing DOACs according to the package insert is warranted for oncology prescribers. Despite the increased risk for bleeding in cancer patients, no clinically significant bleeding events were identified in our patient cohort. This data suggests that the use of DOACs may be safe to use for VTE treatment in cancer patients and may provide foundation for larger, randomized controlled trials to determine whether DOACs should be used for VTE treatment in cancer patients.


Direct oral anticoagulants Neoplasms Retrospective studies Safety Venous thromboembolism 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Noble S, Pasi J (2010) Epidemiology and pathophysiology of cancer-associated thrombosis. Br J Cancer 102:S2–S9CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    National Comprehensive Cancer Network (NCCN) (2018) NCCN Clinical Practice Guidelines in Oncology. Cancer-associated venous thromboembolic disease version 2.2018Google Scholar
  3. 3.
    Gómez-Outes A, Suárez-Gea ML, Lecumberri R, Terleira-Fernández AI, Vargas-Castrillón E, Rocha E (2013) Potential role of new anticoagulants for prevention and treatment of venous thromboembolism in cancer patients. Vasc Health Risk Manag 9:207–228CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lee AYY, Peterson EA (2013) Treatment of cancer-associated thrombosis. Blood 122:2310–2317CrossRefPubMedGoogle Scholar
  5. 5.
    Lyman GH, Bohlke K, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, Clarke JM, Flowers CR, Francis CW, Gates LE, Kakkar AK, Key NS, Levine MN, Liebman HA, Tempero MA, Wong SL, Somerfield MR, Falang A (2015) Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology practice guideline update 2014. J Clin Oncol 33:654–656CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pradaxa [package insert] (2015) Boehringer Ingelheim Pharmaceuticals, Inc, RidgefieldGoogle Scholar
  7. 7.
    Xarelto [package insert] (2015) Janssen Pharmaceuticals, Inc, TitusvilleGoogle Scholar
  8. 8.
    Eliquis [package insert] (2015) Bristol-Myers Squibb Company, PrincetonGoogle Scholar
  9. 9.
    Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H, Baanstra D, Schnee J, Goldhaber SZ, RE-COVER Study Group (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361:2342–2352CrossRefPubMedGoogle Scholar
  10. 10.
    Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, Lensing AW, Misselwitz F, Prins MH, Raskob GE, Segers A, Verhamme P, Wells P, Agnelli G, Bounameaux H, Cohen A, Davidson BL, Piovella F, Schellong S, EINSTEIN Investigators (2010) Oral rivaroxaban for the treatment of symptomatic venous thromboembolism. N Engl J Med 363:2499–2510CrossRefPubMedGoogle Scholar
  11. 11.
    Büller HR, Prins MH, Lensing AW, Decousus H, Minar E, Chulmsky J, Verhamme P, Wells P, Agnelli G, Cohen A, Berkowirz SD, Bounameaux H, Davidson BL, Misselwitz F, Gallus AS, Raskob GE, Schellong S, Segers A, EINSTEIN-PE Investigators (2010) Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 366:1287–1297Google Scholar
  12. 12.
    Agnelli G, Büller HR, Cohen A, Curto M, Gallus AS, Johnson M, Masiukiewicz U, Pak R, Thompson J, Raskob GE, Weitz JI, AMPLIFY Investigators (2013) Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369:799–808CrossRefPubMedGoogle Scholar
  13. 13.
    Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vitch JRE, Wells P, Woller SC, Moores L (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352CrossRefPubMedGoogle Scholar
  14. 14.
    Gon Y, Sakaguchi M, Takasugi J, Mochizuki H (2017) Ischemic stroke in cancer patients treated with direct oral anticoagulants for venous thromboembolism. Thromb Res 154:16–18CrossRefPubMedGoogle Scholar
  15. 15.
    Steinberg BA, Piccini JP (2014) Anticoagulation in atrial fibrillation. BMJ 348:g2116CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Pharmacy, NewYork-Presbyterian HospitalColumbia University Irving Medical CenterNew YorkUSA
  2. 2.Department of PharmacyHackensack University Medical CenterHackensackUSA
  3. 3.Ernest Mario School of Pharmacy, RutgersThe State University of New JerseyPiscatawayUSA
  4. 4.John Theurer Cancer CenterHackensack University Medical CenterHackensackUSA

Personalised recommendations