Direct Oral Anticoagulants in Thromboembolism in Patients with Solid Cancer: Can They Be Privileged?

Omar Abu-Safieh, Marcus Wiemer and Sven Kaese

Pulmonary embolism and deep vein thrombosis are common and serious complications that take place in patients with concomitant malignant disease. Direct oral anticoagulants offer alternatives in prevention and treatment in comparison to traditional anticoagulants and therefore have been investigated by several studies. In patients with malignant disease these drugs, in particular apixaban, edoxaban and rivaroxaban, can be used for the prevention of recurrent deep vein thrombosis and pulmonary embolism. With safety being an important consideration in this vulnerable patient collective there is a natural concern regarding complications in anticoagulation treatment. The completed trials found an equivalent or lower risk of major bleeding events while using direct oral anticoagulants in comparison to traditional anticoagulants. There was an increased risk for gastrointestinal bleeding reported in patients with gastrointestinal cancer or metastases in the gastrointestinal tract. However, collectively, the risk of major bleeding was similar with direct oral anticoagulants compared to low molecular weight heparin or vitamin K antagonists. The efficacy of direct oral anticoagulants in the therapy of pulmonary embolism and deep vein thrombosis in tumor patients has also been investigated. Regarding patients with solid cancer, direct oral anticoagulants provide non-inferiority concerning efficacy and safety for the prevention and treatment of deep vein thrombosis and pulmonary embolism. They can offer an eligible oral alternative to the traditional treatment with vitamin K antagonists or low molecular weight heparin.

View Fulltext Back