Cancer thrombosis: Narrative review

Venous thromboembolism (VTE) is a common disease in patients with cancer and carries a poor prognosis. Although the exact incidence of VTE in patients with cancer lies between 10% and 40%, it is prevalent in a substantial number of patients, either before starting treatment or during the treatment. Vitamin K antagonists have been traditionally used as the preferred agents for the treatment of VTE. However, multiple studies have revealed that low-molecular-weight heparin (LMWH) is a better alternative for controlling and treating the thrombotic process. Direct oral anticoagulants (DOACs) have aroused considerable interest ever since their introduction. Despite the higher risk of bleeding associated with DOACs, patients prefer taking an oral tablet over parenteral therapy. The data from direct comparative studies are slowly emerging but are currently in favor of LMWH as compared to DOACs. However, in certain scenarios, such as renal failure and thrombocytopenia, other drugs should be considered before prescribing LMWH. Here, we have tried to analyze the current treatment strategy for cancer-associated thrombosis by reviewing articles, studies, and the guidelines based on them. We searched in MEDLINE for articles related to thrombosis and anticoagulation in patients with cancer, published between January 2000 and May 2020, with the full text available in the English language.