Direct oral anticoagulants for the treatment of Cancer-Associated Thrombosis

Abstract

Venous thromboembolism is a common complication in the course of neoplastic disease. The increased risk of a blood clot in response to cancer is through various mechanisms. Additionally, systemic chemotherapy and its accompanying procedures increase the risk of a thrombotic event. The occurrence of venous thromboembolism significantly worsens the prognosis of oncology patients. Anticoagulation therapy is used to treat acute stages of venous thromboembolism to prevent relapses. The current guidelines do not recommend anticoagulant prophylaxis for all oncology patients. Only patients at increased risk of blood clots are covered by the prophylaxis. The standard of care in venous thromboembolism is the use of heparin agents: unfractionated, low-molecular-weight, and fondaparinux. The registration of oral anticoagulants, such as dabigatran, rivaroxaban, apixaban, and edoxaban, stimulated research centers to start clinical trials on the use of drugs for the treatment of cancer-associated thrombosis. The advantages of using oral anticoagulants include a quick and predictable effect, an easy and painless route of administration, and no requirement for continuous checking of hematological parameters. The main limitations of these drugs are increased risk of bleeding and drug-drug interactions. The capture points for interactions are the cytochrome P450 enzymes and P-glycoprotein (P-gp) and the Breast cancer Resistance Protein (BCRP). In the population of oncology patients, special attention should be paid to the influence of the applied anticoagulant therapy on the course of chemotherapy as well as on renal and hepatic function. Each time choice of treatment must be supported by careful benefit-risk analysis and assessment of the clinical significance of every drug-drug interaction. Ineffective anticoagulant pharmacotherapy increases the risk of life-threatening thromboembolic events, and over therapy significantly increases the risk of bleeding. Despite the high mortality of thrombotic events, it must not be forgotten that limiting the effectiveness of the applied antitumor treatment has disastrous consequences for the patient.

Keywords

• venous thromboembolism (vte)
• rivaroxaban
• apixaban
• edoxaban
• drug-drug interactions (ddi)
• direct oral anticoagulants (doac)
• cancer-associated thrombosis (cat)