Key result
LMWH and VKA show comparable major bleeding rates in cancer patients with VTE.
Why the study?
What are the bleeding risks and efficacy associated with various anticoagulants (LMWH, VKA, NOACs) for the treatment of VTE in cancer patients?
What are the bleeding risks and efficacy associated with various anticoagulants (LMWH, VKA, NOACs) for the treatment of VTE in cancer patients?
LMWH remains the recommended monotherapy for acute VTE in cancer patients due to superior efficacy over VKAs with comparable bleeding risk, while more evidence is needed for NOACs.
Answers are grounded in this paper and cite their sources.
Comparable bleeding supports LMWH preference over VKA in cancer VTE; leaves open NOAC role pending randomized data.
INTRODUCTION: Patients with cancer are at increased risk of (recurrent) venous thromboembolism. They are also at increased risk of bleeding. This makes treatment of venous thromboembolisms (VTE) in cancer patients challenging. AREAS COVERED: In this review, we will focus on the safety of anticoagulant treatment of VTE in cancer patients. We will discuss the absolute and relative bleeding risks associated with the various types of anticoagulants, specifically focusing on low-molecular-weight heparins (LMWH), vitamin K antagonist (VKA) and the new oral anticoagulants (NOACs). EXPERT OPINION: Monotherapy with LMWH is recommended for treatment of acute VTE in cancer patients. The bleeding risk associated with LMWH is comparable to VKAs, but LMWH are more effective in preventing recurrent VTE. More evidence on the efficacy and safety of NOACs in cancer patients is needed.
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Wilts et al. (2015) conducted a review in Cancer-associated venous thromboembolism (n=2,020). Low-molecular-weight heparins (LMWH) vs. Vitamin K antagonists (VKA) was evaluated on Major bleeding (HR 1.07, 95% CI 0.66-1.73, p=0.80). Low-molecular-weight heparins and vitamin K antagonists were associated with comparable rates of major bleeding in cancer patients with venous thromboembolism (HR 1.07, 95% CI 0.66-1.73).
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