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J Med Vasc. 2018 Sep;43(5):293-301. doi: 10.1016/j.jdmv.2018.07.006. Epub 2018 Aug 17.

[Treatment of cancer associated thrombosis: Which role for direct oral anticoagulants in 2018?]

[Article in French]

Author information

1
Service d'hématologie biologique, Sorbonne université, hôpital Pitié-Salpêtrière, Assistance publique des Hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: corinne.frere@aphp.fr.
2
Unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF 04), hôpital Saint-Louis, Assistance publique des Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France; EA 3518, institut universitaire d'hématologie, université Denis-Diderot, Paris, France. Electronic address: dominique.farge-bancel@aphp.fr.

Abstract

Low molecular weight heparin (LMWH) for at least 3-6 months is the current standard of care for the treatment of cancer associated venous thromboembolism (VTE). Anticoagulation should be continued as long as the cancer is active. In recent years, several direct-acting oral anticoagulants (DOACs) have been approved for the treatment of VTE in the general population. These drugs have progressively emerged as attractive alternatives with the potential to overcome the limitations of LMWH. Due to the lack of high quality prospective data, DOACs are currently not recommended for the treatment of cancer associated VTE yet. Indeed, evidence supporting the use of DOACs in this specific population remains limited, and concerns have been raised about their safety and efficacy in this setting. However, a pattern of increased use of DOACs has been observed in the cancer population. Meta-analyses of Phase III trials of DOACs in VTE as well as analysis of large health care claims databases and non-controlled retrospective studies suggest that DOACs might have similar effectiveness and safety to LMWH for the management of cancer associated VTE. Results from 2 randomized clinical trial (RCT), HOKUSAI-Cancer and SELECT-D, were recently released. Based on a meta-analysis of these 2 RCTs, compared to LMWH, DOACs had lower 6 month recurrent VTE but higher major bleeding. Thus, DOACs should be used with caution in cancer patients and a careful evaluation of the risks and benefits for individual patients is warranted. Ongoing studies will provide much needed evidence to guide clinical care.

KEYWORDS:

Anticoagulants oraux directs; Cancer; Direct oral anticoagulant; Héparines de bas poids moléculaire; Low molecular weight heparin; Maladie thromboembolique veineuse; Venous thromboembolism

PMID:
30217343
DOI:
10.1016/j.jdmv.2018.07.006
[Indexed for MEDLINE]

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