From the Guidelines
Patients with a history of gastric cancer should avoid Direct Oral Anticoagulants (DOACs) such as edoxaban and rivaroxaban due to an increased risk of hemorrhage, and instead consider alternative anticoagulation options like Low Molecular Weight Heparin (LMWH) or apixaban with caution, as recommended by the NCCN guidelines 1. When considering anticoagulation therapy for patients with a history of gastric cancer, it is crucial to weigh the benefits and risks of different medications.
- The NCCN guidelines suggest that DOACs, specifically edoxaban and rivaroxaban, may not be the preferred choice for patients with gastric or gastroesophageal lesions due to the increased risk of bleeding 1.
- Apixaban may be a safer alternative for patients with gastric or gastric esophageal lesions, although it is still categorized as a category 2B recommendation 1.
- LMWH, such as dalteparin or enoxaparin, is preferred for patients with gastric or gastroesophageal lesions, and can be used as an initial therapy for at least 5 days, followed by other anticoagulants like warfarin or dabigatran 1.
- It is essential to consider the individual patient's risk factors, medical history, and current health status when selecting an anticoagulant medication, and to closely monitor them for potential bleeding complications or other adverse effects 1.
From the Research
Medications Contraindicated in Patients with a History of Gastric Cancer
There are no specific medications directly contraindicated in patients with a history of gastric cancer mentioned in the provided studies. However, the following points can be considered:
- The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen has been associated with a reduced risk of gastric cancer in several studies 2, 3, 4, 5, 6.
- Long-term use of NSAIDs, particularly low-dose aspirin, has been shown to decrease the risk of gastrointestinal cancer, including gastric cancer 2, 3.
- The use of proton pump inhibitors (PPIs) may increase the risk of gastric cancer, but this risk can be mitigated by the use of NSAIDs 5.
- Some studies suggest that NSAIDs may have a chemopreventive effect against gastric cancer, particularly in patients who have undergone Helicobacter pylori eradication 5.