Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update.
The development of venous thromboembolism is one of the major causes of morbidity and mortality in patients with cancer. The standard treatment of deep venous thrombosis or pulmonary embolism occurring in patients with active malignancy remains the use of low molecular weight heparins. However, in clinical practice, practitioners are frequently asked about the efficacy and safety of various new oral anticoagulants in cancer patients. In the United States, there are currently 4 different novel oral anticoagulants commercially available with the indication of the treatment of acute venous thromboembolism. These include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). Use of these new medications is appealing due to the ease of administration, avoidance of injections, ability to use in patients with decreased renal or liver function, and consistent efficacy without fooddrug interactions. Currently, the only available data for the use of these new oral anticoagulants in cancer patients is from subgroup analysis of larger studies with no statistical significance. However, this preliminary data is encouraging that the novel oral anticoagulants may be effective and safe for primary and secondary prevention of venous thromboembolism in cancer patients. Further clinical trials are greatly needed for the head-tohead comparison of these novel oral anticoagulants versus low molecular weight heparins. Although the routine use of novel oral anticoagulants for the prevention or treatment of venous thromboembolism in cancer patients cannot be recommended at this time, we strongly support the development of Phase III trials assessing their efficacy and safety in patients with active malignancies compared to the current standard of care treatment with low molecular weight heparin.