Can We Use Direct Oral Anticoagulant Agents to Treat Venous Thromboembolism in Patients with Cancer?

Rivaroxaban was an effective alternative to low-molecular-weight heparin for managing VTE in many — but not all — patients with active cancer.

Current guidelines (Chest 2016; 149:315) do not yet recommend direct-acting oral anticoagulants (DOACs) for managing venous thromboembolism (VTE) in patients with active cancer. However, the DOAC edoxaban (Savaysa) has efficacy similar to that of subcutaneous low-molecular-weight heparin (LMWH), albeit with higher rates of gastrointestinal (GI) bleeding in patients with GI cancers (NEJM JW Gen Med Mar 1 2018 and N Engl J Med 2017 Dec 12; [e-pub]). In a trial of a different DOAC (rivaroxaban [Xarelto]), U.K. investigators randomized >400 patients with active cancer and a first VTE (including about 20% pulmonary emboli [PEs]) to 6 months' treatment with rivaroxaban or LMWH.

The cumulative VTE recurrence rate was significantly lower in the riva…

Reviewing Author

Daniel D. Dressler, MD, MSc, SFHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Daniel D. Dressler, MD, MSc, SFHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Can We Use Direct Oral Anticoagulant Agents to Treat Venous Thromboembolism in Patients with Cancer?

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Reviewing Author