Cancer-associated thrombosis continues to challenge doctors and burden patients. Patients with cancer-associated deep vein thrombosis or pulmonary embolism need anticoagulation; however, specific questions on the choice of anticoagulation and the duration of treatment are still unanswered. This session will address a number of topics that require clarification or are discussed controversially.
Dr. Marcello Di Nisio will discuss the present anticoagulant treatment recommendations for incidental, proximal deep vein thrombosis and pulmonary embolism. He will specifically focus on the extension of pulmonary emboli and the different approaches in extensive and subsegmental pulmonary embolism. Dr. Di Nisio will also discuss the present knowledge on anticoagulation in patients with distal deep vein thrombosis and splanchnic vein thrombosis, the latter of which is frequently found in patients with cancer in the abdominal region, such as pancreatic carcinoma.
Dr. Agnes Lee will review the published literature and real world data on anticoagulant therapy use in patients with cancer-associated venous thromboembolism (VTE), the risks and risk factors of recurrent thrombosis and bleeding, the efficacy and safety of anticoagulation, and patient preference and values regarding long-term anticoagulation. Consensus guidelines generally suggest continuing anticoagulation in patients with ongoing risk factors for recurrent thrombosis with periodic reassessment of the risks and benefits. Dr. Lee will conclude with a pragmatic approach on how to tailor anticoagulant therapy in patients with cancer-associated VTE.
Dr. Ingrid Pabinger will discuss the current knowledge on the use of direct oral anticoagulants (DOACs) for prevention and treatment of cancer-associated VTE. Although patients with cancer have been among those treated with DOACs in pivotal trials, the numbers have been small and the patients might not be comparable to the majority of patients with cancer-associated thrombosis. Presently, interventional studies are ongoing; however, final data are still missing from these trials specifically designed for thrombosis in cancer patients. As prevention of deep vein thrombosis would be desirable for patients with cancer who are at high risk of thrombosis, and DOACs might be safe and easy to use, this aspect needs to be investigated in specific trials.