The treatment of cancer-associated venous thromboembolism in the era of the novel oral anticoagulants

Abstract

Introduction: The initial and long-term administration of low-molecular-weight heparin (LMWH) is now regarded as the treatment of choice for the therapy of patients with cancer-associated venous thromboembolism (CAT). However, LMWH requires daily subcutaneous injections and can induce thrombocytopenia. In recent years, novel direct oral anticoagulants (DOAC) have emerged to potentially replace conventional treatments.Areas covered: The advantages and limitations of conventional approaches for the treatment of CAT are presented and analyzed based on available findings and on recommendations from international guidelines, as is the potential for the DOAC.Expert opinion: LMWH still remains the mainstay of initial and long-term treatment of CAT. Vitamin K antagonists may have a role in patients with inactive cancer and in those with severe renal failure. Whether there is a potential for the DOAC is uncertain. Indeed, most patients with advanced cancer were excluded from the trials addressing their value. Although available findings are encouraging, before implementing them in the routine clinical practice there is the need for dedicated studies in which cancer patients, whichever their severity and prognosis, are allocated to either DOAC or LMWH, which represent the standard of treatment for patients with CAT.