Novel clinical trial data on the treatment of cancer-associated venous thromboembolism with DOACs

Summary

Venous thromboembolism (VTE) is a frequent complication in patients with malignancy. Based on an improved safety and efficacy profile compared to vitamin K antagonists (VKA), current guidelines recommend anticoagulation with low-molecular-weight heparin (LMWH) for 3–6 months as the preferred treatment of cancer-associated VTE. Realworld evidence indicates, however, that guideline adherence is poor in clinical practice, a finding most likely explained by the daily subcutaneous injections and relatively high treatment costs associated with LMWH therapy. Although direct oral anticoagulants (DOACs) may be an attractive alternative owing to their ease of administration and favorable pharmacokinetics compared to VKA, the rather small and insufficiently characterized subgroups of cancer patients included in the large phase-3 trials did not allow translation of study findings into daily practice. With HOKUSAI VTE Cancer (edoxaban) and SELECT-D (rivaroxaban) two large prospective, randomized trials, which have compared DOACs with LMWH for the treatment of cancer-associated VTE, are now available. Both studies showed a reduction in recurrent VTE, but an increased risk in (gastrointestinal and urothelial) bleeding. Taking into account patient preferences and tumor characteristics, future treatment of cancer-associated VTE will thus require a high degree of selection and individualization.

Keywords

Direct oral anticoagulants - low-molecularweight heparin - cancer-associated venous thromboembolism - bleeding - gastrointestinal cancer

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