VTE treatment for patients with active cancer
Treat venous thromboembolism (VTE) (ie deep vein thrombosis [DVT] or pulmonary embolism [PE]) in patients with active cancer1 with low molecular weight heparin (LMWH), apixaban or rivaroxaban. Data on the use of dabigatran for the treatment of VTE in patients with active cancer are lackingKey, 2020. Drug-drug interactions and the patient’s bleeding risk must be assessedLyon, 2022.
Apixaban and rivaroxaban should not be used in patients with unoperated gastrointestinal or genitourinary cancerLyon, 2022. Patients with brain cancer (primary or metastatic) were largely excluded from studies of DOACs because of the risk of intracranial haemorrhageKey, 2020Lyman, 2021Peris, 2016.
Warfarin is not recommended for treatment in patients with active cancer who develop VTE because warfarin has higher VTE recurrence rates compared with LMWHLyon, 2022.
After the initial 3 to 6 month VTE treatment period, a specialist may consider extending therapy with long-term prophylactic doses, for as long as the cancer is activeKey, 2020Lyman, 2021.
For detailed discussion on VTE treatment in patients with active cancer, see the European Society of Cardiology (ESC) Guidelines on cardio-oncology.