The question of the treatment of venous thromboembolism (VTE) in cancer patients puts doctors with a choice between low molecular weight heparin and oral anticoagulants, according to Pannochka, an online publication for girls and women from 14 to 35 years old. net Randomized trials examining treatment options for venous thromboembolism (VTE) have shown that direct-acting oral anticoagulants (CAPDs) can be given to cancer patients who have a low risk of bleeding.
On the other hand, the risks and benefits of CAPD are still unclear..
New research in the treatment of venous thromboembolism in cancer patients.
In a systematic review on the pages of Thrombosis Research, Dr. Maria Cristina Vedovati and her colleagues from the University of Perugia in Italy tried to determine the possibility of preventing VTE in patients with cancer using direct-acting oral anticoagulants.
Current guidelines include the use of low molecular weight heparin (LMWH) for the prevention of venous thromboembolism and for the treatment of VTE in cancer.
However, in recent years, CAPDs have become the standard of treatment for the general population, as they provide a simple oral regimen without the need for anticoagulant control.
Dr. Vedovati and her colleagues examined patients with cancer on an outpatient, surgical and inpatient basis. Scientists have established that several factors must be considered when choosing an anticoagulant agent, including comorbidities, drug interactions, and patient compliance..
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In outpatients with cancer receiving chemotherapy, the use of CAPD for thromboprophylaxis provides significant clinical and economic benefits.. On the other hand, the possibility of replacing LMWH in the context of treatment remains doubtful..
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The risk of cancer-related thromboembolic events is closely related to the stage and type of cancer. For example, metastatic cancer, pancreatic and gastric tumors are more often accompanied by VTE.
Currently, routine thromboprophylaxis is not recommended for most patients.
Dr. Carrie Lenneman of the University of Alabama Heart and Oncology Clinic in Birmingham, USA, believes that pharmaceutical companies should include patients with different types of cancer when preparing clinical trials to study oral anticoagulants..
“Cancer survivors are one of the largest and most difficult patient groups. We need evidence-based recommendations for these patients from early clinical trials, ”says Dr. Lenneman..
The researcher notes that patients with cancer are often excluded from clinical trials because of the high risk or fear that they may not live long enough for effective observation..
When rivaroxaban and apixaban replace heparin?
Dr. Edward Spangenthal, clinical director of cardiology at Roswell Park Cancer Center in Buffalo, NY, says: "
In connection with this feature, American guidelines suggest the use of low molecular weight heparin only in patients with a very high risk of thromboembolism (for example, with multiple myeloma).
Spangenthal noted that the CASSINI and AVERT clinical trials, which evaluated thromboprophylaxis in patients with cancer and high risk of VTE, showed a reduction in the incidence of blood clots due to direct oral anticoagulants.
“Due to their low cost and ease of administration, as well as due to favorable results, I plan to use CAPD as the drugs of choice for treating patients with cancer with atrial fibrillation or VTE. Provided patients have a low risk of bleeding and no interactions between anticoagulants and chemotherapy are expected, ”said Dr. Spangenthal.
The doctor went on to say that cancer patients with VTE should receive anticoagulants for life, unless their cancer is considered cured with little risk of relapse.. He also stated that low-risk patients may require 6 to 12 months of anticoagulant therapy..
“In cancer patients with a very high risk of VTE, low doses of rivaroxaban or apixaban may be considered instead of LMWH, but it would be useful to compare them directly.. I believe it is important for specialist societies such as the American Heart Association to update their guidelines regularly to give practitioners the most relevant guidance on this matter, ”added the expert..
At present, the following reputable organizations recommend the use of low molecular weight heparin for short and long-term treatment of VTE in cancer patients:.
• American College of Thoracic Physicians.
• American Society of Clinical Oncology.
• British Committee for Hematology Standards.
• European Society of Medical Oncology.
• US National Cancer Network, etc..
Are the CASSINI and AVERT results final?
How important is route of administration if most patients prefer CAPD tablets to daily subcutaneous injections?
There are many gaps in the management of venous thromboembolism in cancer patients that need to be filled.
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