What is the role of anticoagulation (prevention of blood clotting) in patients with cancer (malignancy)?

From the Guidelines

Anticoagulation in cancer patients should primarily utilize low molecular weight heparins (LMWHs) for at least 6 months following a venous thromboembolism (VTE) diagnosis, as recommended by the American Society of Clinical Oncology 1. The use of LMWH is preferred over unfractionated heparin (UFH) for the initial 5 to 10 days of anticoagulation, and also for long-term secondary prophylaxis, due to its improved efficacy and safety profile 1. For patients with active cancer, anticoagulation should continue as long as the cancer remains active, and thromboprophylaxis should be considered for high-risk ambulatory cancer patients receiving chemotherapy, particularly those with pancreatic, lung, or gastric cancers 1. The decision to extend anticoagulation beyond 6 months should be made on a case-by-case basis, considering the individual patient's risk of thrombosis and bleeding, as well as the presence of other comorbidities or risk factors 1. It is also important to note that anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications, such as VTE or atrial fibrillation 1. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should educate patients about the signs and symptoms of VTE, in order to promote early detection and treatment 1. Some key points to consider when making decisions about anticoagulation in cancer patients include:

• The patient's individual risk of thrombosis and bleeding
• The presence of other comorbidities or risk factors, such as brain metastases or thrombocytopenia
• The type and stage of cancer
• The patient's overall health status and quality of life
• The potential benefits and risks of anticoagulation, including the risk of bleeding and the potential for improved survival or reduced morbidity.

From the FDA Drug Label

1. 3 Extended Treatment of Symptomatic Venous Thromboembolism (VTE) in Adult Patients with Cancer FRAGMIN is indicated for the extended treatment of symptomatic venous thromboembolism (VTE) (proximal DVT and/or PE), to reduce the recurrence of VTE in adult patients with cancer In these patients, the FRAGMIN therapy begins with the initial VTE treatment and continues for six months [see Clinical Studies (14.5)].

The role of anticoagulation in patients with cancer is to reduce the recurrence of Venous Thromboembolism (VTE). Anticoagulation therapy, such as dalteparin, is indicated for the extended treatment of symptomatic VTE in adult patients with cancer, and it should be continued for six months to reduce the risk of VTE recurrence 2.

From the Research

Role of Anticoagulation in Cancer Patients

• Anticoagulation plays a key role in the treatment of cancer-associated thrombosis (CAT) 3, 4, 5, 6, 7
• Cancer patients have an increased risk of venous thromboembolism (VTE), and VTE is the second most common cause of death among them 3
• Low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) are effective and generally safe options for cancer-associated VTE 3, 4, 5, 6, 7

Treatment and Prevention of VTE in Cancer Patients

• LMWH is recommended as the standard treatment for cancer-associated venous thrombosis 5, 6
• DOACs have been shown to be noninferior to LMWH for preventing recurrent VTE in patients with cancer 7
• DOACs may be an alternative thromboprophylaxis strategy in cancer patients due to their superiorities compared to traditional anticoagulation agents 6
• The long-term use of LMWHs in the settings of cancer and thrombosis is supported by recent clinical trial evidence that demonstrates their equivalent safety and improved efficacy when compared to oral anticoagulants 5

Risks and Complications of Anticoagulation in Cancer Patients

• Patients with cancer who develop thrombosis are more likely to experience a recurrence of VTE and have increased bleeding complications while receiving oral anticoagulant treatment 5
• The main reasons for recurrent VTE can be non-compliance, inadequate dosing of anticoagulants, thrombocytopenia, and malignancy progression 3
• Bleeding, recurrence, thrombocytopenia, drug-drug interactions, renal impairment, nausea-vomiting, and concerns about adherence are common problems that arise during anticoagulation in cancer patients 4