Anticoagulation Strategies in Patients With Cancer: JACC Review Topic of the Week

Patients with active cancer are at an increased risk of arterial and venous thromboembolism (VTE) and bleeding events. Historically, in patients with cancer, low molecular weight heparins have been preferred for treatment of VTE, whereas warfarin has been the standard anticoagulant for stroke preven...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2019-03, Vol.73 (11), p.1336-1349
Main Authors: Mosarla, Ramya C, Vaduganathan, Muthiah, Qamar, Arman, Moslehi, Javid, Piazza, Gregory, Giugliano, Robert P
Format: Article
Language:English
Subjects:
Anticoagulants
Anticoagulants - classification
Anticoagulants - pharmacology
Atrial Fibrillation - blood
Atrial Fibrillation - complications
Bleeding
Blood Coagulation - drug effects
Cancer
Cancer therapies
Cardiac arrhythmia
Cardiology
Catheters
Clinical trials
Clinical Trials as Topic
Competition
Drug dosages
Epidemiology
Fibrillation
Health risks
Heparin
Historical account
Humans
Kinases
Low molecular weights
Medical diagnosis
Medical research
Molecular weight
Mortality
Mutation
Neoplasms - blood
Neoplasms - complications
Pathogenesis
Patients
Practice Guidelines as Topic
Risk reduction
Stroke
Thromboembolism
Thromboembolism - etiology
Thromboembolism - prevention & control
Thrombosis
Warfarin
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Description
Summary:Patients with active cancer are at an increased risk of arterial and venous thromboembolism (VTE) and bleeding events. Historically, in patients with cancer, low molecular weight heparins have been preferred for treatment of VTE, whereas warfarin has been the standard anticoagulant for stroke prevention in patients with atrial fibrillation (AF). More recently, direct oral anticoagulants (DOACs) have been demonstrated to reduce the risk of venous and arterial thromboembolism in large randomized clinical trials of patients with VTE and AF, respectively, thus providing an attractive oral dosing option that does not require routine laboratory monitoring. In this review, we summarize available clinical trial data and guideline recommendations, and outline a practical approach to anticoagulation management of VTE and AF in cancer.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2019.01.017