Anticoagulation Strategies in Patients With Cancer: JACC Review Topic of the Week |
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| Authors: | Ramya C Mosarla Muthiah Vaduganathan Arman Qamar Javid Moslehi Gregory Piazza Robert P Giugliano |
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| Institution: | 1. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;2. Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts;3. TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;4. Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee |
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| Abstract: | Patients with active cancer are at an increased risk of arterial and venous thromboembolism (VTE) and bleeding events. Historically, in patients with cancer, low molecular weight heparins have been preferred for treatment of VTE, whereas warfarin has been the standard anticoagulant for stroke prevention in patients with atrial fibrillation (AF). More recently, direct oral anticoagulants (DOACs) have been demonstrated to reduce the risk of venous and arterial thromboembolism in large randomized clinical trials of patients with VTE and AF, respectively, thus providing an attractive oral dosing option that does not require routine laboratory monitoring. In this review, we summarize available clinical trial data and guideline recommendations, and outline a practical approach to anticoagulation management of VTE and AF in cancer. |
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| Keywords: | anticoagulation atrial fibrillation bleeding cancer cardio-oncology venous thromboembolism AF atrial fibrillation CVC central venous catheter DOAC direct oral anticoagulant agent LMWH low-molecular weight heparins RCT randomized clinical trial VTE venous thromboembolism |
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