Direct oral anticoagulants are increasingly recommended as the primary treatment for cancer-associated thrombosis, offering a convenient and effective alternative to low molecular weight heparin.
DOACs are the preferred first-line anticoagulants for cancer-associated thrombosis, though LMWH remains an important alternative for patients with high bleeding risk or gastrointestinal tumors.
It has been 200 years since the first case of cancer-associated thrombosis (CAT) was reported. Venous thromboembolism (VTE) remains a leading cause of morbidity and mortality in cancer patients. Malignant tumors interact with the coagulation system in complex ways. CAT continues to pose a significant challenge in clinical practice. The risk factors for CAT are complex and multifactorial, primarily including patient, cancer, and therapy-related factors. We have introduced assessment models for CAT and bleeding risk, but the performance of these models has been less than satisfactory. Currently, the main anticoagulant drugs for treating CAT include vitamin K antagonists (VKAs), low molecular weight heparin (LMWH), and direct oral anticoagulants (DOACs). We have provided a detailed overview of the advantages and disadvantages of these three types of drugs and suggestions on choosing the appropriate type of medication for different clinical scenarios. CAT incidence, pathophysiology, risk factors, risk prediction models, and recent advancements in treatment and management are summarized in this review.
Wan et al. (2025) conducted a review in Cancer-associated venous thromboembolism. Anticoagulants (DOACs, LMWH, VKAs) was evaluated. Direct oral anticoagulants are increasingly recommended as the primary treatment for cancer-associated thrombosis, offering a convenient and effective alternative to low molecular weight heparin.