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Blood Res 2022; 57(S1):
Published online April 30, 2022
https://doi.org/10.5045/br.2022.2022025
© The Korean Society of Hematology
Challenging issues in the management of cancer-associated venous thromboembolism
Correspondence to : Ho-Young Yhim, M.D., Ph.D.
Department of Internal Medicine, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea
E-mail: yhimhy@jbnu.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Venous thromboembolism (VTE) is a common complication among patients with cancer and is associated with delays in underlying cancer treatment and increases in morbidity and mortality. Acute and long-term treatments with low-molecular-weight-heparin (LMWH) have been recommended as a standard of care for patients with cancer with VTE for the past 20 years. Direct oral anticoagulants (DOACs) have recently emerged as a new therapeutic modality for cancer-associated VTE because of the convenience of oral administration and rapid onset of action. Our knowledge regarding DOACs for cancer-associated VTD has expanded in recent years. Thus, this study aimed to review recent major pivotal trials comparing DOACs with LMWH for managing cancer-associated VTE. Moreover, a recently updated understanding of DOACs in the treatment of cancer-associated VTE in specific challenging situations is presented.
Keywords Cancer, Direct oral anticoagulant, Venous thromboembolism
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Review Article
Blood Res 2022; 57(S1): S44-S48
Published online April 30, 2022 https://doi.org/10.5045/br.2022.2022025
Copyright © The Korean Society of Hematology.
Challenging issues in the management of cancer-associated venous thromboembolism
Ho-Young Yhim
Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea
Correspondence to:Ho-Young Yhim, M.D., Ph.D.
Department of Internal Medicine, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea
E-mail: yhimhy@jbnu.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Venous thromboembolism (VTE) is a common complication among patients with cancer and is associated with delays in underlying cancer treatment and increases in morbidity and mortality. Acute and long-term treatments with low-molecular-weight-heparin (LMWH) have been recommended as a standard of care for patients with cancer with VTE for the past 20 years. Direct oral anticoagulants (DOACs) have recently emerged as a new therapeutic modality for cancer-associated VTE because of the convenience of oral administration and rapid onset of action. Our knowledge regarding DOACs for cancer-associated VTD has expanded in recent years. Thus, this study aimed to review recent major pivotal trials comparing DOACs with LMWH for managing cancer-associated VTE. Moreover, a recently updated understanding of DOACs in the treatment of cancer-associated VTE in specific challenging situations is presented.
Keywords: Cancer, Direct oral anticoagulant, Venous thromboembolism
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Table 1 . Study characteristics of major pivotal trials comparing DOAC with LMWH..
Hokusai VTE Cancer SELECT-D ADAM VTE CARAVAGGIO Trial design Non-inferiority phase 3 Pilot Superiority phase 3 Non-inferiority phase 3 Sample size 1,046 406 287 1,155 DOAC arm LMWH for 5 days then edoxaban 60 mg/day PO Rivaroxaban 15 mg PO twice a day for 21 days, then 20 mg PO once a day Apixaban 10 mg PO twice a day for 7 days, then 5 mg PO twice a day Apixaban 10 mg PO twice a day for 7 days, then 5 mg PO twice a day LMWH arm Dalteparin 200 U/kg daily for 1 month followed by 150 U/kg daily Dose reduction of DOAC Edoxaban 30 mg/day PO in patients with <60 kg of body weight; creatinine clearance 30–50 mL/min; drug-to-drug interactions N/A N/A N/A Treatment duration 12 months 6 months 6 months 6 months Type of qualifying VTE Acute symptomatic or incidentally detected lower extremity proximal DVT or PE of segmental or more proximal pulmonary artery Acute symptomatic lower extremity proximal DVT, symptomatic PE, or incidental PE Acute lower extremity or upper extremity DVT, PE, splanchnic vein, or cerebral vein thrombosis Acute symptomatic or incidentally detected lower extremity proximal DVT or PE of segmental or more proximal pulmonary artery Cancer excluded Basal cell/squamous cell cancer of the skin Basal cell/squamous cell cancer of the skin Basal cell/squamous cell cancer of the skin Basal cell/squamous cell cancer of the skin Esophageal or gastroesophageal cancer Primary brain tumor Intracerebral metastasis Acute leukemia Primary outcome Composite of recurrent VTE or major bleeding Recurrent VTE Major bleeding Recurrent VTE Major bleeding
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