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Cancers (Basel). 2019 Jan 10;11(1). pii: E71. doi: 10.3390/cancers11010071.

Recent Advances in the Management of Cancer-Associated Thrombosis: New Hopes but New Challenges.

Author information

1
Institute of Cardiometabolism And Nutrition, INSERM UMRS_1166, Sorbonne Université, F-75013 Paris, France. corinne.frere@aphp.fr.
2
Department of Haematology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, F-75013 Paris, France. corinne.frere@aphp.fr.
3
Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of reference for rare systemic autoimmne diseases (FAI2R), Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, F-75010 Paris, France. ilham.benzidia@aphp.fr.
4
Department of Haematology, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, F-75012 Paris, France. zora.marjanovic@aphp.fr.
5
Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of reference for rare systemic autoimmne diseases (FAI2R), Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, F-75010 Paris, France. dominique.farge-bancel@aphp.fr.
6
Department of Medicine, McGill University, Montreal, QC H3A 0E7, Canada. dominique.farge-bancel@aphp.fr.

Abstract

Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer patients and leads to a significant increase in health care costs. Cancer patients often suffer from multiple co-morbidities and have both a greater risk of VTE recurrence and bleeding compared to non-cancer patients. Anticoagulation is therefore challenging. For many years, long-term therapy with Low-Molecular-Weight Heparin (LMWH) was the standard of care for the management of cancer-associated VTE. Direct oral anticoagulants (DOAC), which offer the convenience of an oral administration and have a rapid onset of action, have recently been proposed as a new option in this setting. Head-to-head comparisons between DOAC and LMWHs for the treatment of established VTE are now available, and data on the efficacy and safety of these drugs for primary prophylaxis of VTE in ambulatory cancer patients receiving systemic anticancer therapy are emerging. This narrative review aims to summarize the main recent advances in the prevention and treatment of cancer-associated VTE, including recent data on the use of individualized factors to stratify the risk of VTE in each individual patient, quality-of-life in patients treated with LMWH, and the place that DOACs will likely take in the cancer-associated VTE management landscape.

KEYWORDS:

cancer; direct oral anticoagulant; low molecular weight heparin; venous thromboembolism

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