Current Management of Cancer-associated Venous Thromboembolism: Focus on Direct Oral Anticoagulants

J Korean Med Sci. 2019 Feb 1;34(6):e52. doi: 10.3346/jkms.2019.34.e52. eCollection 2019 Feb 18.


Cancer-associated venous thromboembolism (CAT) is a common complication associated with high morbidity and mortality. In accordance with major clinical trials comparing low-molecular-weight heparin (LMWH) with a vitamin K antagonist (VKA), LMWH is currently the standard treatment for CAT, owing to its efficacy for thrombosis recurrence and improved safety profile compared to VKA. Over the past few years, direct oral anticoagulants (DOACs) have emerged as potential alternative therapies to LMWH due to their convenient route of administration and predictable pharmacokinetics, but evidence for their use in CAT is inconclusive, as only a small fraction of the study populations in these trials had CAT. Recently, two large head-to-head trials comparing DOACs to LMWH in CAT patients reported comparable efficacies of DOACs with increased bleeding risk. Occasionally, CAT treatment can be challenging due to the heterogeneity of underlying malignancies and comorbidities. Renal insufficiency and gastrointestinal defects are the main obstacles in anticoagulant selection. Careful choice of treatment candidates and proper anticoagulant strategies are critical for the treatment of CAT; hence, more studies are required to address these challenges.

Keywords: Cancer-associated Venous Thromboembolism; Direct Oral Anticoagulants; Low-Molecular-Weight Heparin.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / therapeutic use*
  • Clinical Trials as Topic
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Neoplasms / complications
  • Neoplasms / pathology*
  • Renal Insufficiency / complications
  • Renal Insufficiency / pathology
  • Risk Factors
  • Venous Thromboembolism / drug therapy*
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / pathology
  • Vitamin K / antagonists & inhibitors


  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Vitamin K