Prophylaxis and management of cancer-associated thrombosis: Practical issues about anticoagulant use

Translated title of the contribution: Prophylaxis and management of cancer-associated thrombosis: Practical issues about anticoagulant use

David Malka, Nicolas Girard, David M. Smadja, Christine Chevreau, Stéphane Culine, Anne Lesur, Roman Rouzier, François Rozet, Jean Philippe Spano, Jean Yves Blay

Research output: Contribution to journalReview articlepeer-review

Abstract

Cancer-associated thrombosis (CAT) is a common complication resulting from various vascular mechanisms related to cancer, antitumoral therapy and patient status, and is associated with a poor prognosis. Anticoagulants recommended for CAT treatment or prevention mainly include low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs). Regarding thromboprophylaxis, a situation for which LMWH is a preferred option due to a lower risk of hemorrhage especially in patients with unresected gastro-intestinal and genito-urinary malignancies, the identification of patients at risk is a major issue. For patients with established CAT, the main issue is the choice of the most appropriate anticoagulant therapy. Because of the convenience of oral formulation, DOACs are an attractive option, and their efficacy has been shown in randomized trials. However, such studies are limited by selection biases, which make the analyzed population not representative of the real-life setting, as for instance cancers associated with a high risk of hemorrhage, or antitumoral therapies (e.g., tyrosine kinase inhibitors) known to interact with DOACs and then modifying their bioavailability. Caution associated with DOAC use is highlighted by most updated guidelines that recommend a case-by-case-based approach. The aim of the present paper is to help the oncologists make the most appropriate decision regarding the choice of anticoagulant therapy in a context of thromboprophylaxis or established CAT management in a patient with a solid tumor. The main issues are addressed through key practical questions, the answers of which are based on the current guidelines and additional published data or expert opinions.

Translated title of the contributionProphylaxis and management of cancer-associated thrombosis: Practical issues about anticoagulant use
Original languageFrench
Pages (from-to)212-224
Number of pages13
JournalBulletin du Cancer
Volume110
Issue number2
DOIs
StatePublished - Feb 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022 Société Française du Cancer

Keywords

  • Anticoagulant
  • Cancer
  • Hemorrhage
  • Heparin
  • Thrombosis

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