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DOI: 10.1055/a-2431-6818
Challenging Situations in the Treatment of Cancer-Associated Thrombosis
Abstract
Cancer-associated thrombosis (CAT) is a common clinical problem in the treatment of cancer patients posing some unique challenges. These include the need to balance between the risk of recurrent thromboembolic events and bleeding complications in the individual cancer patient. A frequently encountered dilemma is the need for long-term anticoagulation in the setting of active malignancy. Until now, optimal duration, intensity, and type of anticoagulation in cancer patients remain an area of ongoing debate. In this case-based review, we present several challenging clinical scenarios and provide guidance on management. For optimal treatment results, CAT generally requires a multidisciplinary approach including specialists for thrombosis and hemostasis as well as hematology and oncology. Individual patient preferences should always be taken into account, especially in clinical situations with weak treatment evidence.
Zusammenfassung
Die Tumor-assoziierte Thrombose ist ein häufiges klinisches Problem bei Krebspa-tient*innen und gekennzeichnet durch spezifische Behandlungsherausforderungen. Dazu gehört vor allem die schwierige Abwägung des individuellen Thrombose- und Blutungsrisikos. Ein ständiges Dilemma ist die Notwendigkeit der Langzeitantikoagulation bei aktiver Krebserkrankung. Bis heute sind die optimale Dauer, Intensität und Art der Antikoagulation bei Krebspatient*innen umstritten.
In dieser fallbasierten Übersichtsarbeit gehen wir auf schwierige klinische Situationen ein und präsentieren mögliche Lösungsansätze. Für ein optimales Ergebnis sollte die Behandlung der Tumor-assoziierte Thrombose stets multidisziplinär erfolgen beziehungsweise nach Abstimmung zwischen Hämostaseologen und Hämatoonkologen. Ebenso wichtig ist die Berücksichtigung der individuellen Patientenpräferenz insbesondere in klinischen Situationen mit schlechter Evidenzlage.
Authors' Contributions
E.B. was involved in patient treatment and wrote the manuscript; S.M., J.B-W., and K.T-G. were involved in patient treatment, revised the manuscript, and approved the final version for publication.
Competing Interests
E.B. received travel compensation from Novartis. S.M. received honoraria and institutional research support from Bayer AG, Daiichi Sankyo, Pfizer, Swedish Orphan Biovitrum GmbH, Bristol-Myers Squibb, and Biotest AG. J.B-W. received honoraria and institutional research support from Alexion/AstraZeneca, Bayer AG, Boehringer Ingelheim, Daiichi Sankyo, Bristol-Myers Squibb, Leo Pharma, Mitsubishi Pharma, Norgine, and Pfizer. K.T-G. received consulting fees from Takeda, Roche, Grifols, and SOBI; honoraria from Amgen, Roche, Sanofi, SOBI, Grifols, Novartis, and Pfizer; and travel support from Grifols and Takeda.
Publikationsverlauf
Eingereicht: 24. April 2024
Angenommen: 08. Oktober 2024
Artikel online veröffentlicht:
04. Dezember 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
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