Risk of recurrent venous thromboembolism in cancer patients after discontinuation of anticoagulant therapy

Submitted: 2 February 2024
Accepted: 24 February 2024
Published: 16 May 2024
Abstract Views: 176
PDF: 93
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Anticoagulant therapy is recommended for cancer-related venous thromboembolism (VTE). Recurrent VTE prevention is the main goal of this treatment. The majority of evidence-based practice guidelines recommend anticoagulant treatment for at least 6 months. Based on individual assessment of potential benefits and risks, tolerability, drug availability, patient preference, and cancer activity, active cancer patients should continue anticoagulant treatment beyond the 6-month course. When cancer is no longer active or the risk outweighs the benefit, anticoagulant therapy is usually stopped after 3-6 months. Until recently, there was little data on the risk of recurrent VTE in cancer-associated VTE patients after stopping anticoagulants. New results and evidence synthesis have emerged in the last 3 years. Recurring VTE occurs in over 30% in the 5 years after treatment discontinuation. In the first six months, recurrence rates are 10-15%. Recurrences reach 31% at 2 years and stabilize between 2 and 5. Duration of prior anticoagulation does not affect cumulative recurrence. The high risk of recurrent VTE after discontinuing treatment supports guidelines to continue anticoagulant treatment if cancer is active. Stopping anticoagulants after 3-6 months may not be ideal, so randomized clinical trials should be conducted quickly. This review highlights the need to improve cancer patients' primary VTE prevention efforts.



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Khorana A, Mackman N, Falanga A, et al. Cancer-associated venous thromboembolism. Nat Rev 2022:8:1-18. DOI: https://doi.org/10.1038/s41572-022-00336-y
Raskob G, Wendelboe A, Campbell J, et al. Cancer-associated venous thromboembolism: incidence and features in a racially diverse population. J Thromb Haemost 2022;20:2366-78. DOI: https://doi.org/10.1111/jth.15818
Mulder F, Horvath-Puho E, vanEs N, et al. Venous thromboembolism in cancer patients: a population-based study. Blood 2021;137:1959-69. DOI: https://doi.org/10.1182/blood.2020007338
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Cancer-associated venous thromboembolic disease. Version 2. National Comprehensive Cancer Network 2023. Available from: https://www.nccn.org/login?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/vte.pdf
Falanga A, Ay C, Di Nisio M, et al. Venous thromboembolism in cancer patients: ESMO clinical practice guideline. Ann Oncol 2023;34:452-67. DOI: https://doi.org/10.1016/j.annonc.2022.12.014
Lyman G, 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
Key N, Khorana A, Kuderer N, 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
Farge D, Frere C, Connors J, et al. 2022 International clinical practice guidelines for treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19. Lancet Oncol 2022;23:e334-e347.
O’Connell, Escalanti C, Goldhaber S, et al. Treatment of cancer-associated venous thromboembolism with low-molecular-weight heparin or direct oral anticoagulants: patient selection, controversies and caveats. The Oncologist 2021;26:e8-e16. DOI: https://doi.org/10.1002/onco.13584
Moik F, Colling M, Mahe I, et al. Extended anticoagulation treatment for cancer-associated thrombosis – rates of recurrence and bleeding beyond 6 months: a systematic review. J Thromb Haemost 2022;20:619-34. DOI: https://doi.org/10.1111/jth.15599
Van Hylckama Vlieg MAM, Nasserinejad K, Visser C, et al. The risk of recurrent venous thromboembolism after discontinuation of anticoagulant therapy in patients with cancer-associated thrombosis: a systematic review and meta-analysis. Lancet eClinicalmedicine 2023;64:102194. DOI: https://doi.org/10.1016/j.eclinm.2023.102194
Lapebie F, Bura-Riviere A, Espitia O, et al. Predictors of recurrence of cancer-associated venous thromboembolism after discontinuation of anticoagulant therapy: a multicenter cohort study. J Thromb Haemost 2023;21:2189-201. DOI: https://doi.org/10.1016/j.jtha.2023.04.010
Agnelli G, Prandoni P, Santamaria M, et al. for the Warfarin Optimal Duration Italian Trial Investigators. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators. N Engl J Med 2001;345:165-9. DOI: https://doi.org/10.1056/NEJM200107193450302
Mahe I, Agnellli 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
Chan N, Weitz J. New therapeutic targets for the prevention and treatment of venous thromboembolism with a focus on Factor XI inhibitors. Arterioscler Thromb Vasc Biol 2023; 43:1755-63. DOI: https://doi.org/10.1161/ATVBAHA.123.318781

How to Cite

Raskob, G. E. (2024). Risk of recurrent venous thromboembolism in cancer patients after discontinuation of anticoagulant therapy. Bleeding, Thrombosis and Vascular Biology, 3(s1). https://doi.org/10.4081/btvb.2024.124