Abstract
The association between malignant neoplasms and venous thromboembolism (VTE) is well recognized, and anticoagulation therapy is commonly administered in the oncological setting. The treatment approach to cancer-associated VTE differs substantially compared to the general population, as chronic low-molecular-weight heparin (LMWH) has been shown to be more effective than vitamin K antagonist (VKA). There are also several challenges specific to the cancer patient. These include an increased risk of bleeding, higher rates of anticoagulation failure, drug interactions, decreased oral intake, chemotherapy-induced thrombocytopenia, and cerebral metastases.
Most of the literature in the field concerns the use of LMWH for cancer-associated VTE. Data is accumulating about the use of direct oral anticoagulants (DOACs) in this setting. DOACs offer improved patient quality of life and reduced cost compared to LMWH, although no published randomized trial has directly compared these two classes of anticoagulants in patients with cancer.
Even though atrial fibrillation is by far the most common indication for anticoagulation in developed countries, there are little data about the best choice of agent when this arrhythmia occurs in cancer patients. It is unclear if the risk of ischemic stroke or systemic embolization is increased in the presence of malignancy, although the risk of bleeding is likely higher. Notably, VKA are still administered for the treatment of AF despite the difficulties inherent to cancer patients.