Key result
Factor XI inhibitors represent a promising next-generation therapeutic target for cancer-associated venous thromboembolism to address the high bleeding risks associated with current anticoagulants.
This editorial highlights the clinical need for safer anticoagulants, such as Factor XI inhibitors, in cancer-associated VTE to mitigate the high bleeding risks associated with current therapies.
Venous thromboembolism (VTE) is one of the most frequent cardiovascular emergencies in cancer patients (1), and its management is one of the most important topics in oncocardiology.In recent years, direct oral anticoagulants (DOACs) have been used frequently in Japanese cancer patients with VTE because low-molecular-weight heparin is not available for VTE treatment in Japan.Three DOACs are currently available for the treatment of VTE in Japan: edoxaban, rivaroxaban, and apixaban.Unlike the other two DOACs, edoxaban requires parenteral anticoagulation in the acute phase; however, in real-world clinical practice, parenteral anticoagulation is often avoided prior to administration of edoxaban due to patient background, bleeding risk, and other factors.In this issue of Internal Medicine, Ueno et al.(2) investigated the frequency of parenteral anticoagulation pretreatment and the impact of pretreatment on clinical outcomes, such as VTE recurrence and bleeding, in cancer patients with VTE treated with edoxaban.In their study, 60% of the patients were not pretreated with parenteral anticoagulants and had more severe VTE, more inflammatory reactions, higher levels of D-dimer, less active cancer complications, and more frequent anemia than patients who were not pretreated.Importantly, no significant differences were found in the safety or efficacy in patients with and without pretreatment with parenteral anticoagulants.The most problematic side effect of VTE treatment in cancer patients is bleeding.Indeed, cancer patients discontinue anticoagulants more often than those without cancer due to bleeding complications, whether from the tumor itself, vascular vulnerability due to the use of antitumor drugs, or tissue damage due to radiation therapy, surgery, or catheter insertion.A recent randomized controlled trial (RCT), the CANVAS (Cancer Related VTE Anticoagulation Strategies) trial, which was designed to address real-world
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Kazuko Tajiri (2023) conducted an editorial in Cancer-associated Venous Thromboembolism. Factor XI inhibitors was evaluated. Factor XI inhibitors represent a promising next-generation therapeutic target for cancer-associated venous thromboembolism to address the high bleeding risks associated with current anticoagulants.
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