Proceedings of the 12th International Conference on Thrombosis and Hemostasis Issues in Cancer, 2024
Vol. 3 No. s1 (2024)
Venous thromboembolism treatment in patients with cancer: reflections on an evolving landscape
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 12 January 2024
Accepted: 13 February 2024
Accepted: 13 February 2024
1939
Views
879
Downloads
Authors
Cancer is a leading cause of morbidity and mortality worldwide. It is also one of the strongest risk factors for venous thromboembolism (VTE), reported in approximately 20% of all cases of VTE diagnosed. The thrombotic effect of cancer and its treatments, however, is highly variable among patients and changes over the course of their cancer. Anticoagulant therapy remains the cornerstone of VTE treatment, but it is associated with a substantial rate of VTE recurrence and the potential for serious bleeding. The risk of bleeding in patients with cancer is also dependent on the cancer type and its treatments, often revealing underlying tumor invasion of mucosal or parenchymal tissues, and treatment complications such as thrombocytopenia or coagulopathy. Over the past few decades, efforts to improve the efficacy and safety of anticoagulant therapy for the treatment and prevention of cancer-associated thromboembolism have resulted in changes in the standard of practice. This evolution has been made possible largely through the development of new anticoagulants. This review will reflect on the major advances in the treatment of cancer-associated thrombosis and offer insights on how to address unmet needs in this field.
Downloads
Download data is not yet available.
Citations
Ferlay J, Colombet M, Soerjomataram I, Parkin DM, et al. Cancer statistics for the year 2020: an overview. Int J Cancer 2021. DOI: https://doi.org/10.1002/ijc.33588
Cohen AT, Katholing A, Rietbrock S, et al. Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A population-based cohort study. Thromb Haemost 2017;117:57-65. DOI: https://doi.org/10.1160/TH15-08-0686
Mahajan A, Brunson A, Adesina O, et al. The incidence of cancer-associated thrombosis is increasing over time. Blood Adv 2022;6:307-20. DOI: https://doi.org/10.1182/bloodadvances.2021005590
Mulder FI, Horvath-Puho E, van Es N, et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood 2021;137:1959-69. DOI: https://doi.org/10.1182/blood.2020007338
Khorana AA, Connolly GC. Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol 2009;27:4839-47. DOI: https://doi.org/10.1200/JCO.2009.22.3271
Frere C, Font C, Esposito F, et al. Incidence, risk factors, and management of bleeding in patients receiving anticoagulants for the treatment of cancer-associated thrombosis. Support Care Cancer 2022;30:2919-31. DOI: https://doi.org/10.1007/s00520-021-06598-8
Hirsh J, Eikelboom JW, Chan NC. Fifty years of research on antithrombotic therapy: achievements and disappointments. Eur J Intern Med 2019;70:1-7. DOI: https://doi.org/10.1016/j.ejim.2019.10.023
Barritt DW, Jordan SC. Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. Lancet 1960;1: 1309-12. DOI: https://doi.org/10.1016/S0140-6736(60)92299-6
Levine M, Hirsh J. The diagnosis and treatment of thrombosis in the cancer patient. Semin Oncol 1990;17:160-71.
Sutherland DE, Weitz IC, Liebman HA. Thromboembolic complications of cancer: epidemiology, pathogenesis, diagnosis, and treatment. Am J Hematol 2003;72:43-52. DOI: https://doi.org/10.1002/ajh.10263
Chan A, Woodruff RK. Complications and failure of anticoagulation therapy in the treatment of venous thromboembolism in patients with disseminated malignancy. Aust N Z J Med 1992;22:119-22. DOI: https://doi.org/10.1111/j.1445-5994.1992.tb02789.x
van Dongen CJ, van den Belt AG, Prins MH, Lensing AW. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev 2004:CD001100. DOI: https://doi.org/10.1002/14651858.CD001100.pub2
Khorana AA, Streiff MB, Farge D, et al. Venous thromboembolism prophylaxis and treatment in cancer: a consensus statement of major guidelines panels and call to action. J Clin Oncol 2009;27:4919-26. DOI: https://doi.org/10.1200/JCO.2009.22.3214
Akl EA, Kahale L, Barba M, et al. Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer. Cochrane Database Syst Rev 2014:CD006650. DOI: https://doi.org/10.1002/14651858.CD006650.pub4
Khorana AA, McCrae KR, Milentijevic D, et al. Current practice patterns and patient persistence with anticoagulant treatments for cancer-associated thrombosis. Res Pract Thromb Haemost 2017;1:14-22. DOI: https://doi.org/10.1002/rth2.12002
Athanazio RA, Ceresetto JM, Marfil Rivera LJ, et al. direct oral anticoagulants for the treatment of cancer-associated venous thromboembolism: a latin american perspective. Clin Appl Thromb Hemost 2022;28:10760296221082988. DOI: https://doi.org/10.1177/10760296221082988
Chew TW, Gau CS, Wen YW, et al. Epidemiology, clinical profile and treatment patterns of venous thromboembolism in cancer patients in Taiwan: a population-based study. BMC Cancer 2015;15:298. DOI: https://doi.org/10.1186/s12885-015-1200-6
Rahme E, Feugere G, Sirois C, et al. Anticoagulant use in patients with cancer associated venous thromboembolism: a retrospective cohort study. Thromb Res 2013;131:210-7. DOI: https://doi.org/10.1016/j.thromres.2012.12.004
van Doormaal FF, Raskob GE, Davidson BL, et al. Treatment of venous thromboembolism in patients with cancer: subgroup analysis of the Matisse clinical trials. Thromb Haemost 2009;101:762-9. DOI: https://doi.org/10.1160/TH08-09-0563
Schulman S, Goldhaber SZ, Kearon C, et al. Treatment with dabigatran or warfarin in patients with venous thromboembolism and cancer. Thromb Haemost 2015;114:150-7. DOI: https://doi.org/10.1160/TH14-11-0977
Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 2020;38:496-520. DOI: https://doi.org/10.1200/JCO.19.01461
Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv 2021;5:927-74. DOI: https://doi.org/10.1182/bloodadvances.2021004734
van Es N, Coppens M, Schulman S, et al. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood 2014;124:1968-75. DOI: https://doi.org/10.1182/blood-2014-04-571232
Carrier M, Cameron C, Delluc A, Castellucci L, Khorana AA, Lee AY. Efficacy and safety of anticoagulant therapy for the treatment of acute cancer-associated thrombosis: a systematic review and meta-analysis. Thromb Res 2014;134: 1214-9. DOI: https://doi.org/10.1016/j.thromres.2014.09.039
Rossel A, Robert-Ebadi H, Combescure C, et al. Anticoagulant therapy for acute venous thrombo-embolism in cancer patients: a systematic review and network meta-analysis. PLoS One 2019;14:e0213940. DOI: https://doi.org/10.1371/journal.pone.0213940
Carrier M, Blais N, Crowther M, et al. Treatment algorithm in cancer-associated thrombosis: updated Canadian expert consensus. Curr Oncol 2021;28:5434-51. DOI: https://doi.org/10.3390/curroncol28060453
Frere C, Farge D, Schrag D, et al. Direct oral anticoagulant versus low molecular weight heparin for the treatment of cancer-associated venous thromboembolism: 2022 updated systematic review and meta-analysis of randomized controlled trials. J Hematol Oncol 2022;15:69. DOI: https://doi.org/10.1186/s13045-022-01289-1
Ageno W, Vedovati MC, Cohen A, et al. Bleeding with apixaban and dalteparin in patients with cancer-associated venous thromboembolism: results from the Caravaggio Study. Thromb Haemost 2021;121:616-24. DOI: https://doi.org/10.1055/s-0040-1720975
Kraaijpoel N, Di Nisio M, Mulder FI, et al. Clinical impact of bleeding in cancer-associated venous thromboembolism: results from the Hokusai VTE cancer study. Thromb Haemost 2018;118:1439-49. DOI: https://doi.org/10.1055/s-0038-1667001
Wang TF, Khorana AA, Agnelli G, et al. Treatment of cancer-associated thrombosis: recent advances, unmet needs, and future direction. Oncologist 2023;28:555-64. DOI: https://doi.org/10.1093/oncolo/oyad116
Abdulla A, Davis WM, Ratnaweera N, et al. A meta-analysis of case fatality rates of recurrent venous thromboembolism and major bleeding in patients with cancer. Thromb Haemost 2020;120:702-13. DOI: https://doi.org/10.1055/s-0040-1708481
Weitz JI, Chan NC. Novel antithrombotic strategies for treatment of venous thromboembolism. Blood 2020;135:351-9. DOI: https://doi.org/10.1182/blood.2019000919
Santagata D, Donadini MP, Ageno W. Factor XI inhibitors for the prevention of cardiovascular disease: a new therapeutic approach on the horizon? Blood Rev 2023;62:101119. DOI: https://doi.org/10.1016/j.blre.2023.101119
Salomon O, Gailani D. A proposal for managing bleeding in patients on therapeutic factor XI(a) inhibitors. J Thromb Haemost 2022;20:32-8. DOI: https://doi.org/10.1111/jth.15579
Ray WA, Chung CP, Murray KT, et al. Association of oral anticoagulants and proton pump inhibitor cotherapy with hospitalization for upper gastrointestinal tract bleeding. JAMA 2018;320:2221-30. DOI: https://doi.org/10.1001/jama.2018.17242
Joseph P, Glynn R, Lonn E, et al. Rosuvastatin for the prevention of venous thromboembolism: a pooled analysis of the HOPE-3 and JUPITER randomized controlled trials. Cardiovasc Res 2022;118:897-903. DOI: https://doi.org/10.1093/cvr/cvab078
Stopa JD, Zwicker JI. The intersection of protein disulfide isomerase and cancer associated thrombosis. Thromb Res 2018;164:S130-S5. DOI: https://doi.org/10.1016/j.thromres.2018.01.005
Beckman JD, DaSilva A, Aronovich E, et al. JAK-STAT inhibition reduces endothelial prothrombotic activation and leukocyte-endothelial proadhesive interactions. J Thromb Haemost 2023;21:1366-80. DOI: https://doi.org/10.1016/j.jtha.2023.01.027
Hisada Y, Mackman N. Cancer-associated pathways and biomarkers of venous thrombosis. Blood 2017;130:1499-506. DOI: https://doi.org/10.1182/blood-2017-03-743211
Carney BJ, Wang TF, Ren S, et al. Anticoagulation in cancer-associated thromboembolism with thrombocytopenia: a prospective, multicenter cohort study. Blood Adv 2021;5: 5546-53. DOI: https://doi.org/10.1182/bloodadvances.2021005966
Cohen O, Caiano LM, Levy-Mendelovich S. Cancer-associated splanchnic vein thrombosis: clinical implications and management considerations. Thromb Res 2024;234:75-85. DOI: https://doi.org/10.1016/j.thromres.2023.12.014
Sanfilippo KM, Moik F, Candeloro M, et al. Unanswered questions in cancer-associated thrombosis. Br J Haematol 2022;198:812-25. DOI: https://doi.org/10.1111/bjh.18276
Yamashita Y, Morimoto T, Muraoka N, et al. Edoxaban for 12 months versus 3 months in patients with cancer with isolated distal deep vein thrombosis (ONCO DVT study): an open-label, multicenter, randomized clinical trial. Circulation 2023;148:1665-76. DOI: https://doi.org/10.1161/CIRCULATIONAHA.123.066360
Mahe I, Agnelli G, Ay C, et al. extended anticoagulant treatment with full- or reduced-dose apixaban in patients with cancer-associated venous thromboembolism: rationale and design of the API-CAT Study. Thromb Haemost 2022;122:646-56. DOI: https://doi.org/10.1055/a-1647-9896
Otero R, Solier-Lopez A, Sanchez-Lopez V, et al. Biomarkers of venous thromboembolism recurrence after discontinuation of low molecular weight heparin treatment for cancer-associated thrombosis (HISPALIS-Study). Cancers (Basel) 2022;14. DOI: https://doi.org/10.3390/cancers14112771
Schmidt RA, Al Zaki A, Desilet N, et al. Patient characteristics and long-term outcomes beyond the first 6 months after a diagnosis of cancer-associated venous thromboembolism. Thromb Res 2020;188:106-14. DOI: https://doi.org/10.1016/j.thromres.2020.02.005
White C, Noble SIR, Watson M, et al. Prevalence, symptom burden, and natural history of deep vein thrombosis in people with advanced cancer in specialist palliative care units (HIDDen): a prospective longitudinal observational study. Lancet Haematol 2019;6:e79-e88. DOI: https://doi.org/10.1016/S2352-3026(18)30215-1
Candeloro M, Guman NAM, Kraaijpoel N, Di Nisio M. Risk assessment models for thrombosis and anticoagulant related bleeding in ambulatory cancer patients. Semin Thromb Hemost 2021;47:972-81. DOI: https://doi.org/10.1055/s-0040-1722608
Tawil N, Bassawon R, Rak J. Oncogenes and clotting factors: the emerging role of tumor cell genome and epigenome in cancer-associated thrombosis. Semin Thromb Hemost 2019;45:373-84. DOI: https://doi.org/10.1055/s-0039-1687891
Michaels L. Cancer incidence and mortality in patients having anticoagulant therapy. Lancet. 1964;2:832-5. DOI: https://doi.org/10.1016/S0140-6736(64)90685-3
Zacharski LR, Henderson WG, Rickles FR, et al. Effect of warfarin on survival in small cell carcinoma of the lung. Veterans Administration Study No. 75. JAMA 1981;245:831-5. DOI: https://doi.org/10.1001/jama.1981.03310330021017
Smorenburg SM, Vink R, Otten HM, Swaneveld F, Buller HR. The effects of vitamin K-antagonists on survival of patients with malignancy: a systematic analysis. Thromb Haemost 2001;86:1586-7. DOI: https://doi.org/10.1055/s-0037-1616771
Montroy J, Lalu MM, Auer RC, et al. The efficacy and safety of low molecular weight heparin administration to improve survival of cancer patients: a systematic review and meta-analysis. Thromb Haemost 2020;120:832-46. DOI: https://doi.org/10.1055/s-0040-1709712
Mousa SA, Petersen LJ. Anti-cancer properties of low-molecular-weight heparin: preclinical evidence. Thromb Haemost 2009;102:258-67. DOI: https://doi.org/10.1160/TH08-12-0832
Chiasakul T, Zwicker JI. The impact of warfarin on overall survival in cancer patients. Thromb Res 2022;213:S113-S9. DOI: https://doi.org/10.1016/j.thromres.2021.11.004
Datta T, Brunson A, Mahajan A, et al. Racial disparities in cancer-associated thrombosis. Blood Adv 2022;6:3167-77. DOI: https://doi.org/10.1182/bloodadvances.2021006209
Wiredu C, Haynes N, Guerra C, Ky B. Racial and ethnic disparities in cancer-associated thrombosis. Thromb Haemost 2022;122:662-5. DOI: https://doi.org/10.1055/a-1674-0259
da Costa WL, Jr., Guffey D, Oluyomi A, et al. Patterns of venous thromboembolism risk, treatment, and outcomes among patients with cancer from uninsured and vulnerable populations. Am J Hematol 2022;97:1044-54. DOI: https://doi.org/10.1002/ajh.26623
Noble S, Prout H, Nelson A. Patients’ experiences of LIving with CANcer-associated thrombosis: the PELICAN study. Patient Prefer Adherence 2015;9:337-45. DOI: https://doi.org/10.2147/PPA.S79373
Lee LH, Nagarajan C, Tan CW, Ng HJ. Epidemiology of cancer-associated thrombosis in Asia: a systematic review. Front Cardiovasc Med 2021;8:669288. DOI: https://doi.org/10.3389/fcvm.2021.669288
How to Cite
1.
Lee AY. Venous thromboembolism treatment in patients with cancer: reflections on an evolving landscape. Bleeding Thromb Vasc Biol [Internet]. 2024 Feb. 29 [cited 2026 Apr. 16];3(s1). Available from: https://www.btvb.org/btvb/article/view/111
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Similar Articles
- Società Italiana di Emostasi e Trombosi, PO21 | PSYCHOLOGICAL IMPACT OF CANCER-ASSOCIATED THROMBOSIS: DUAL BURDEN AND IMPLICATIONS FOR QUALITY OF LIFE AND INTEGRATED PATIENT-CENTERED CARE , Bleeding, Thrombosis and Vascular Biology: Vol. 5 No. s1 (2026)
- CO05 | Long-term management of upper extremity catheter-related thrombosis in female patients with cancer: a retrospective cohort study , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- Società Italiana di Emostasi e Trombosi, PO28 | CLINICAL IMPLICATIONS OF ANTICOAGULANT DRUG INTERACTIONS WITH TARGETED AND IMMUNE THERAPIES IN ONCOLOGY: A CONTEMPORARY RISK STRATIFICATION FRAMEWORK , Bleeding, Thrombosis and Vascular Biology: Vol. 5 No. s1 (2026)
- Società Italiana di Emostasi e Trombosi, PO40 | RADAR, UK-MRA MYELOMA XV - COMPARING MRD-GUIDED TREATMENT ESCALATION AND DE-ESCALATION STRATEGIES IN PATIENTS WITH NEWLY DIAGNOSED MYELOMA SUITABLE FOR STEM CELL TRANSPLANTATION: THROMBOPROPHYLAXIS SUBGROUP STUDY PROTOCOL , Bleeding, Thrombosis and Vascular Biology: Vol. 5 No. s1 (2026)
- CO07 | Real word management of anticoagulant therapy in brain metastasis: moving toward a multidisciplinary approach in complex cases , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- Società Italiana di Emostasi e Trombos, OC06 | PRIMARY THROMBOPROPHYLAXIS IN ADVANCED PANCREATIC DUCTAL ADENOCARCINOMA UNDERGOING SYSTEMIC ANTICANCER TREATMENT: A CANCER-CENTER COHORT STUDY ON CLINICAL PRACTICE AND OUTCOMES , Bleeding, Thrombosis and Vascular Biology: Vol. 5 No. s1 (2026)
- Roger Lijnen, Désiré Collen, The key to fibrinolysis and thrombolysis , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 3 (2025)
- Stefania Cavazza, Gualtiero Palareti*, Still unmet problems with low molecular weight heparin prophylaxis of venous thromboembolism. An Italian survey , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 3 (2025)
- PO92 | Challenging management of portal vein thrombosis in a cirrhotic patient on hormone therapy after breast cancer , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO94 | The use of antidepressant drugs and benzodiazepine hypnotics as an unusual risk factor for VTE , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
You may also start an advanced similarity search for this article.
