title: The newer anticoagulants in thrombosis control in cancer patients.
abstract: Cancer and hemostasis are strongly correlated and the development of venous thromboembolism (VTE) has a major adverse impact on the outcome of cancer patients. Treatment of cancer-associated VTE is far more challenging than treating VTE in the non-cancer population, as the clinical course of cancer patients is characterized by increased rates of both recurrent thromboembolic episodes and bleeding complications. This has led to the development of a distinct management approach towards VTE in patients with active cancer. Low-molecular-weight heparins (LMWHs) currently represent the therapeutic agent of choice, as a result of a proven higher efficacy compared to vitamin K antagonists (VKAs). However, as LMWHs require daily subcutaneous injections, weight-adjusted doses, and still confers high risks of recurrent VTE and bleeding complications, management of cancer-associated VTE warrants further optimization. In recent years several novel, target-specific oral anticoagulants have been introduced and evaluated in clinical trials. These new anticoagulants display several advantages compared to conventional anticoagulants. This review will evaluate their trial results up-to-date with a particular focus on the cancer patients included in these trials. The potential of these agents in the setting of cancer-associated VTE will be discussed and directions for future research will be provided.
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: p.l.den_exter@lumc.nl.
authors.forename: Paul L
authors.initials: PL
authors.lastname: den Exter
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: van der Hulle
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Frederikus A
authors.initials: FA
authors.lastname: Klok
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants