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Novel oral anticoagulants in the treatment of cancer patients

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Biernacka R., Lewandowski T., Andrzejuk J., Szmyd M.
OncoReview
|
2014
|
vol. 4
|
issue 1
A11-17
EN
Cancer and its treatment are well-recognized risk factors for venous thromboembolism. The risk of thrombotic complications increases 4–7-fold in cancer patients and coexistence of both pathologies is associated with shorter survival. Incidence of thrombosis depends on the tumour type, antineoplastic and supportive therapy, and patient-related factors such as age, physical activity and comorbidities. Current recommendations of scientific societies indicate a dominant role of low molecular weight heparins in the treatment and prevention of venous thromboembolism in cancer patients. Long duration of the anticoagulant effect, and the subcutaneous administration route of heparins call for a safer therapeutic option, and one that would be more convenient for the patient. New oral anticoagulants: dabigatran, rivaroxaban, and apixaban, are indicated as prevention of venous thromboembolism following an orthopaedic surgery, and as stroke prevention in nonvalvular atrial fibrillation, with rivaroxaban also applied in the treatment of acute deep vein thrombosis and pulmonary embolism. In the trials evaluating the efficacy of novel oral anticoagulants, they have been compared with enoxaparin or vitamin K antagonists. Cancer patients accounted for a small percentage of the trial population, and they were rarely analysed in subgroup analysis. It was only in the phase II ADVOCATE study that the target group were patients receiving chemotherapy. Direct comparison between test drug and low molecular weight heparins was not performed. The currently available study results do not allow us to recommend the new oral anticoagulants for the treatment and prevention of venous thromboembolism associated with cancer.
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