Safe and effective treatment of venous Thromboembolism associated with Cancer: focus on direct Oral Anticoagulants in Asian patients
Issued Date
2022-12-01
Resource Type
eISSN
21623619
Scopus ID
2-s2.0-85140621690
Journal Title
Experimental Hematology and Oncology
Volume
11
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Experimental Hematology and Oncology Vol.11 No.1 (2022)
Suggested Citation
Lee L.H., Danchaivijitr P., Uaprasert N., Gill H., Sacdalan D.L., Ho G.F., Parakh R., Pai P., Lee J.K., Rey N., Cohen A.T. Safe and effective treatment of venous Thromboembolism associated with Cancer: focus on direct Oral Anticoagulants in Asian patients. Experimental Hematology and Oncology Vol.11 No.1 (2022). doi:10.1186/s40164-022-00331-9 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/83520
Title
Safe and effective treatment of venous Thromboembolism associated with Cancer: focus on direct Oral Anticoagulants in Asian patients
Author's Affiliation
Siriraj Hospital
De La Salle Medical and Health Sciences Institute
Medanta - The Medicity
National Taiwan University Hospital
University of the Philippines College of Medicine
Singapore General Hospital
University of Malaya Medical Centre
King's College London
The University of Hong Kong
Faculty of Medicine, Chulalongkorn University
The Vascular Clinic
De La Salle Medical and Health Sciences Institute
Medanta - The Medicity
National Taiwan University Hospital
University of the Philippines College of Medicine
Singapore General Hospital
University of Malaya Medical Centre
King's College London
The University of Hong Kong
Faculty of Medicine, Chulalongkorn University
The Vascular Clinic
Other Contributor(s)
Abstract
Cancer-associated thrombosis (CAT) poses a significant disease burden and the incidence in Asian populations is increasing. Anticoagulation is the cornerstone of treatment, but can be challenging due to the high bleeding risk in some cancers and the high risk of recurrent venous thromboembolism (VTE) in patients with malignancies. Direct oral anticoagulants (DOACs) are well established as first-choice treatments for VTE in non-cancer patients, offering a more convenient and less invasive treatment option than low-molecular-weight heparin (LMWH). Asian patients have exhibited comparable efficacy and safety outcomes with other races in trials of DOACs for VTE in the general population. Although no specific data are available in Asian patients with CAT, results from randomized controlled trials of apixaban, edoxaban, or rivaroxaban versus the LMWH, dalteparin, indicate that DOACs are a reasonable alternative to LMWH for anticoagulation in Asian patients with CAT. This is further supported by analyses of real-world data in Asian populations demonstrating the efficacy and safety of DOACs in Asian patients with CAT. Apixaban, edoxaban, or rivaroxaban are recommended in the most recently updated international guidelines as first-line therapy for CAT in patients without gastrointestinal or genitourinary cancers and at low risk of bleeding. An increased risk of major gastrointestinal bleeding was evident with edoxaban or rivaroxaban, but not apixaban, versus dalteparin in the clinical trials, suggesting that apixaban could be a safe alternative to LMWH in patients with gastrointestinal malignancies. Determining the optimal anticoagulant therapy for patients with CAT requires careful consideration of bleeding risk, tumor type, renal function, drug–drug interactions, financial costs, and patients’ needs and preferences.