Treatment of cancer-associated thrombosis: perspectives on the use of novel oral anticoagulants.

Therapeutic options for the management of venous thromboembolism have expanded with the introduction of novel oral anticoagulants (NOACs). These agents offer significant advantages in convenience and simplicity, and large, well-designed clinical trials have shown that NOACs are comparable in efficacy and safety to traditional therapy using low molecular weight heparin (LMWH) followed by a vitamin K antagonist in most patients with deep vein thrombosis or pulmonary embolism. However, these results cannot be extrapolated to the general oncology population because randomized clinical trials have included very few and highly selected patients with cancer. Furthermore, how well these agents perform in comparison to LMWH, the drug of choice for both initial and long-term treatment of cancer-associated thrombosis, has not been evaluated. Other limitations of particular importance to patients with cancer, such as chemotherapy interaction, renal impairment, or hepatic involvement with metastases also need to be carefully considered because these patients have higher risks of recurrent thrombosis and bleeding. The use of NOACs is currently not recommended by international consensus guidelines but is now being explored in ongoing clinical trials. The results are eagerly awaited.