Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece.
Unit of Minimally Invasive Vascular Surgery, Mediterraneο Hospital, 16675 Athens, Greece.
Medicina (Kaunas). 2021 Sep 12;57(9):960. doi: 10.3390/medicina57090960.
Venous thromboembolism (VTE) is a common complication among patients suffering from malignancies, leading to an increased mortality rate. Novel randomized trials have added valuable information regarding cancer-associated thrombosis (CAT) management using direct oral anticoagulants (DOACs). The aim of this study is to present an overview of the current literature and recommendations in CAT treatment. A few randomized control trials (RCTs) have been integrated suggesting that DOACs may be effectively applied in CAT patients compared to low molecular weight heparins (LMWHs) with a decreased mortality and VTE recurrence rate. However, the risk of bleeding is higher, especially in patients with gastrointestinal malignancies. Real-world data are in accordance with these RCT findings, while in the currently available recommendations, DOACs are suggested as a reliable alternative to LMWH during the initial, long-term, and extended phase of treatment. Data retrieved from the current literature, including RCTs and "real-world" studies, aim to clarify the role of DOACs in CAT management, by highlighting their benefits and remarking upon the potential adverse outcomes. Current recommendations suggest the use of DOACs in well-selected patients with an increasing level of evidence through years.
静脉血栓栓塞症（VTE）是恶性肿瘤患者的常见并发症，导致死亡率增加。新型随机试验为使用直接口服抗凝剂（DOAC）治疗癌症相关性血栓形成（CAT）提供了有价值的信息。本研究旨在概述 CAT 治疗的现有文献和建议。一些随机对照试验（RCT）表明，与低分子肝素（LMWH）相比，DOAC 可能在 CAT 患者中更有效，死亡率和 VTE 复发率降低。然而，出血风险更高，尤其是胃肠道恶性肿瘤患者。真实世界的数据与这些 RCT 发现一致，而在目前的建议中，DOAC 被建议作为 LMWH 的可靠替代品，用于初始、长期和扩展治疗阶段。从当前文献中检索到的数据，包括 RCT 和“真实世界”研究，旨在通过强调其益处并注意潜在的不良后果，阐明 DOAC 在 CAT 管理中的作用。随着时间的推移，当前的建议建议在选择合适的患者中使用 DOAC，证据水平不断提高。
