Why the study?
Do direct oral anticoagulants (DOACs) prevent VTE recurrence or major bleeding compared to low-molecular-weight heparins (LMWH) in patients with cancer-associated venous thromboembolism?
Do direct oral anticoagulants (DOACs) prevent VTE recurrence or major bleeding compared to low-molecular-weight heparins (LMWH) in patients with cancer-associated venous thromboembolism?
DOACs are an attractive alternative to LMWH for the treatment of cancer-associated VTE, though switching requires careful consideration of the patient's cancer, treatment course, and comorbidities.
Answers are grounded in this paper and cite their sources.
Supports DOACs as a convenient alternative to LMWH in cancer-associated V.
Patients with cancer are at significantly higher risk of developing, and dying from, venous thromboembolism (VTE). The CLOT trial demonstrated superiority of low-molecular-weight heparins (LMWH) over warfarin for recurrent VTE and established LMWH as the standard of care for cancer-associated VTE. However, with patients living longer with metastatic cancer, long-term injections are associated with significant cost and injection fatigue. Direct oral anticoagulants (DOACs) are an attractive alternative for treatment of cancer-associated VTE. Meta-analysis of subgroup data of patients with cancer from the large DOAC VTE trials and small non-randomized studies have found no difference in VTE recurrence or major bleeding. With this limited evidence, clinicians may decide to switch their patients who require long-term anticoagulation from LMWH to a DOAC. This requires careful consideration of the interplay between the patient's cancer and treatment course, with their underlying comorbidities.
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Smrke et al. (2017) studied this question.
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