Key result
This review highlights that while DOACs are as effective as LMWH for cancer-associated VTE, they carry a higher risk of gastrointestinal bleeding, making LMWH preferable for active luminal cancers.
Why the study?
Venous and arterial thromboembolism are frequent cancer complications, but risk assessment models for thrombotic risk in gastrointestinal cancer have several limitations.
What are the current options for prophylaxis and treatment of cancer-associated ATE, VTE, and SVT in patients with gastrointestinal cancers?
What are the current options for prophylaxis and treatment of cancer-associated ATE, VTE, and SVT in patients with gastrointestinal cancers?
In patients with GI cancer, DOACs are effective for VTE prophylaxis and treatment, but LMWH remains the standard of care for those with active luminal cancer due to a higher risk of GI bleeding with DOACs.
May support LMWH preference for VTE in active luminal GI cancers; leaves open optimal DOAC use in non-luminal malignancies.
BACKGROUND: Venous (VTE) and arterial thromboembolism (ATE) are frequent complications of cancer. Risk assessment models (RAM) for stratification of the thrombotic risk in patients with gastrointestinal (GI) cancer have several limitations. SUMMARY: While pancreatic and stomach cancer are considered very high risk in all RAM, the risk of colorectal cancer differs between RAM, and esophageal cancer and cholangiocarcinoma were underrepresented or not included in any RAM. In addition, up to 49% of patients with pancreatic cancer develop splanchnic vein thrombosis (SVT). Prophylaxis with low-molecular-weight heparins (LMWH) in ambulatory cancer patients is associated with a positive risk-benefit ratio only in high-risk patients and LMWH have been the standard of care for the treatment of cancer-associated VTE and SVT over the last years. Direct oral anticoagulants (DOAC) have been shown to be equally effective compared to LMWH, but bleedings from the GI tract are more frequent. Therefore, recent guidelines suggest the use of DOAC for VTE treatment and for prophylaxis in ambulatory patients at high risk for VTE, but patients at high risk for bleeding, especially with active luminal cancer, should receive LMWH. KEY MESSAGES: This review discusses RAM and the current options for prophylaxis and treatment of cancer-associated ATE, VTE, and SVT focusing on GI cancers.
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Christian Pfrepper (2020) conducted a review in Cancer-associated thromboembolism (focusing on gastrointestinal cancers). Direct oral anticoagulants (DOAC) and Low-molecular-weight heparins (LMWH) was evaluated. This review highlights that while DOACs are as effective as LMWH for cancer-associated VTE, they carry a higher risk of gastrointestinal bleeding, making LMWH preferable for active luminal cancers.
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