Proceedings of the 12th International Conference on Thrombosis and Hemostasis Issues in Cancer, 2024
Vol. 3 No. s1 (2024)
Risk of recurrent venous thromboembolism in cancer patients after discontinuation of anticoagulant therapy
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: 2 February 2024
Accepted: 24 February 2024
Accepted: 24 February 2024
745
Views
371
Downloads
Authors
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 When cancer is no longer active or the risk outweighs the benefit, anticoagulant therapy is usually stopped after 3-6 months.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.
Downloads
Download data is not yet available.
Citations
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
1.
Raskob GE. Risk of recurrent venous thromboembolism in cancer patients after discontinuation of anticoagulant therapy. Bleeding Thromb Vascul Biol [Internet]. 2024 May 16 [cited 2025 Nov. 7];3(s1). Available from: https://www.btvb.org/btvb/article/view/124
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Similar Articles
- PO67 | Pancreatic cancer in a 71-year-old severe hemophilia A patient with inhibitors and sustained zero bleeding during emicizumab prophylaxis , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- Betül Ünlü, Neha Joshi, Jamie M. O'Sullivan, Endothelial cell dysfunction in cancer: a not-so-innocent bystander , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. s1 (2024)
- CS03 | Khorana risk score and genomic profiling for prediction of venous thromboembolism in ovarian cancer , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- Daniela Tormene, Elena Campello, Chiara Simion, Anna Poretto, Paolo Prandoni, Paolo Simioni, Combined oral contraceptives and the risk of venous thromboembolism carriers of antithrombin, protein C or S deficiency: Sub-analysis of a prospective cohort study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
- PO96 | Patient management with arteriovenous thrombotic manifestation and hemorrhagic complications , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO29 | Quality of anticoagulation as a predictor of early left ventricular thrombosis resolution: a retrospective cohort study , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- Setor K. Kunutsor, Sudhir Kurl, Ari Voutilainen, Jari Laukkanen, Circulating albumin-to-fibrinogen ratio may be a risk indicator for venous thromboembolism: findings from a population-based prospective cohort study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- CO16 | The predictive value of high-sensitivity C-reactive protein for assessing thrombosis risk in non-small cell lung cancer , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO66 | Viscoelastic tests in disseminated intravascular coagulation associated with aortic aneurysm , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO77 | The clinical awareness of mixing test interpretation in the era of complex reporting algorithm: do we forget the origins? , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
You may also start an advanced similarity search for this article.
