title: Pros and cons of new oral anticoagulants in the treatment of venous thromboembolism in patients with cancer.
abstract: Patients with cancer account for 20 % of cases of venous thromboembolism (VTE). Cancer patients are at increased risk for VTE during the entire course of their disease, also in absence of traditional VTE risk factors. Furthermore, patients with VTE and cancer have an estimated risk of bleeding of 15-20 % per year while on anticoagulant treatment. For these reasons, treatment of acute VTE in patients with cancer remains a clinical challenge. In clinical studies, which included about 27,000 patients, new oral anticoagulants (NOACs) have been shown to be as effective and safe as conventional anticoagulation (heparin given with and followed by vitamin K antagonists) for the treatment of VTE. In these studies, 1227 patients with active cancer were enrolled. Preliminary results of subgroup analyses and meta-analyses of randomized clinical trials suggest that NOACs could represent an alternative to conventional anticoagulation in patients with active cancer. Further "ad hoc" studies evaluating the clinical benefit of treatment with NOACs in patients with VTE and cancer are needed.
authors.affiliation: Medicina Interna e Cardiovascolare-Stroke Unit, Dipartimento di Medicina Interna, Università di Perugia, Via Gerardo Dottori, 06100, Perugia, Italy, melina.verso@unipg.it.
authors.forename: Melina
authors.initials: M
authors.lastname: Verso
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Prandoni
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000069604:Dabigatran / Q000009:adverse effects / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D011728:Pyridones / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban / Q000009:adverse effects / Q000627:therapeutic use; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban
references.citation: Thromb Haemost. 2013 Nov;110(5):959-65
references.pmid: 23945725
references.citation: Blood. 2002 Nov 15;100(10):3484-8
references.pmid: 12393647
references.citation: J Thromb Haemost. 2014 Jul;12(7):1116-20
references.pmid: 24819040
references.citation: N Engl J Med. 2009 Dec 10;361(24):2342-52
references.pmid: 19966341
references.citation: N Engl J Med. 2013 Oct 10;369(15):1406-15
references.pmid: 23991658
references.citation: Arch Intern Med. 2000 Mar 27;160(6):761-8
references.pmid: 10737275
references.citation: Thromb J. 2013 Sep 20;11(1):21
references.pmid: 24053656
references.citation: Arch Intern Med. 2002 Aug 12-26;162(15):1729-35
references.pmid: 12153376
references.citation: Clin Appl Thromb Hemost. 2006 Oct;12(4):389-96
references.pmid: 17000884
references.citation: J Clin Oncol. 2015 Feb 20;33(6):654-6
references.pmid: 25605844
references.citation: Br J Haematol. 2006 Feb;132(3):277-85
references.pmid: 16409292
references.citation: Chest. 2012 Feb;141(2 Suppl):e419S-e496S
references.pmid: 22315268
references.citation: Circulation. 2014 Feb 18;129(7):764-72
references.pmid: 24344086
references.citation: Blood. 2014 Sep 18;124(12 ):1968-75
references.pmid: 24963045
references.citation: N Engl J Med. 2010 Dec 23;363(26):2499-510
references.pmid: 21128814
references.citation: Intern Emerg Med. 2010 Oct;5 Suppl 1:S27-30
references.pmid: 20865471
references.citation: Intern Emerg Med. 2014 Aug;9(5):559-67
references.pmid: 23943559
references.citation: N Engl J Med. 2013 Aug 29;369(9):799-808
references.pmid: 23808982
references.citation: Am J Med. 2006 Dec;119(12 ):1062-72
references.pmid: 17145251
references.citation: Cochrane Database Syst Rev. 2011 Jun 15;(6):CD006650
references.pmid: 21678361
references.citation: Intern Emerg Med. 2015 Jun;10 (4):499-506
references.pmid: 25539954
references.citation: J Clin Oncol. 2000 Sep;18(17):3078-83
references.pmid: 10963635
references.citation: BMJ. 2012 Jun 27;344:e3979
references.pmid: 22740565
references.citation: N Engl J Med. 2012 Apr 5;366(14):1287-97
references.pmid: 22449293
references.citation: N Engl J Med. 2003 Jul 10;349(2):146-53
references.pmid: 12853587
references.citation: J Thromb Haemost. 2006 Sep;4(9):1950-6
references.pmid: 16961602
references.citation: Intern Emerg Med. 2014 Aug;9(5):497-9
references.pmid: 24858721
references.citation: JAMA. 2005 Feb 9;293(6):715-22
references.pmid: 15701913
references.citation: Arch Intern Med. 2000 Mar 27;160(6):809-15
references.pmid: 10737280
references.citation: Chest. 2015 Feb;147(2):475-483
references.pmid: 25211264