Abstract
Venous thromboembolic events in oncologic patients are frequent and significantly worsen their prognosis. Low-molecular-weight heparin used to be a preferred option in prophylaxis and treatment of cancer associated thromboembolism.
Recently, new evidence about efficacy and safety of direct oral anticoagulants in cancer patients have emerged. Updated guidelines suggest the use of rivaroxaban or apixaban in primary thromboprophylaxis in ambulatory patients starting chemotherapy provided they have no risk of bleeding and no risk of interaction with antitumor drugs.
For the treatment of cancer associated thromboembolism, based on available evidence, edoxaban or rivaroxan can be used, and recently, new favorable data about apixaban have been published. Direct oral anticoagulants are the treatment of choice in selected oncologic patients.
In those with a high risk of bleeding, especially bleeding from gastrointestinal or genitourinary tract, or a risk of potential strong drug-drug interaction, low-molecular-weight heparin remains a preferred option. The treatment and prophylaxis of cancer associated thromboembolism requires individualized approach, shared decision making and regular follow-up of the patient.