What is the clinical evidence from this study?

Study design: Review. Population: Cancer-associated thrombosis. Intervention: Anticoagulation therapy (DOACs, LMWH, FXI inhibitors).

What question did this study set out to answer?

This review aims to address the challenges of anticoagulation management in patients with cancer-associated thrombosis.

April 25, 2026Open Access

Anticoagulation challenges in cancer patients: prevention, detection, and treatment strategies

Key Result

Cancer-associated thrombosis affects up to 20% of oncology patients and requires personalized anticoagulation strategies to carefully balance severe thrombotic and bleeding risks.

Key Points

This review aims to address the challenges of anticoagulation management in patients with cancer-associated thrombosis.
Review of three clinical cases involving different thrombotic scenarios in cancer patients.
Analysis of prevention strategies and therapeutic approaches, including risk stratification tools and emerging therapies.
Discussion of immune checkpoint inhibitors and their interplay with anticoagulation.
Case 1 shows prevention strategies for thrombosis with central venous catheters.
Case 2 illustrates the complexity of managing venous thromboembolism in metastatic prostate cancer with cardiovascular comorbidities.
Case 3 highlights risks associated with immune checkpoint inhibitors and atrial fibrillation in lung cancer.

Structured PICO

Population

Cancer patients at risk for or presenting with cancer-associated thrombosis, including venous thromboembolism and arterial thrombotic events.

Intervention

Anticoagulation management, risk stratification tools (e.g., Khorana Score, EHR-CAT), and thromboprophylaxis strategies.

This review emphasizes the need for individualized anticoagulation and risk stratification strategies to safely manage the complex balance of thrombotic and bleeding risks in cardio-oncology patients.

Limitations

The Khorana Score has limited sensitivity and underestimates thrombotic risk in certain cancers like lung and gastrointestinal tumors.
The EHR-CAT risk assessment model requires access to comprehensive electronic health record data, which may be less familiar to clinicians.
The ThroLy Score is limited to lymphoma and is not applicable to solid tumors.
D-dimer has reduced specificity for VTE detection in oncology patients due to nonspecific elevations related to tumor burden, inflammation, or advanced age.

Abstract

Cancer-associated thrombosis is one of the most common and serious complications in oncology patients, contributing significantly to morbidity and mortality. This prothrombotic state is driven by cancer-related factors, systemic inflammation, and treatment-induced endothelial injury. Anticoagulation management in these patients is challenging, as both thrombotic and bleeding risks must be carefully balanced, particularly in those with cardiovascular comorbidities. This review examines the complexities of anticoagulation in cancer-associated thrombosis through three clinical cases. Case 1 focuses on thrombosis associated with central venous catheters, exploring prevention strategies and therapeutic approaches. Case 2 discusses the management of venous thromboembolism in metastatic prostate cancer with concurrent cardiovascular disease, emphasizing the challenges of overlapping arterial and venous risks. Case 3 highlights the interplay between immune checkpoint inhibitors and postoperative atrial fibrillation in a patient with non-small cell lung cancer, exploring immune-mediated mechanisms and their implications for anticoagulation. The review also discusses advances in risk stratification tools, detection methods, and emerging therapies such as FXI inhibitors. Effective management of anticoagulation in cancer patients requires personalized strategies that consider cancer-specific risks, treatment-related factors, and comorbidities. Advances in biomarkers, predictive models, and innovative therapies hold promise for improving outcomes in this high-risk population.

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