Anticoagulation options remain the same in those with or without cancer. It
is used for the prevention and/or treatment of thrombus in those with low bleeding risk.
No anticoagulation is recommended in active bleeding, recent surgery, pre-existing
bleeding disorders, coagulopathy, or platelet count <50,000/microL. The immediate
treatment options include low molecular weight heparin (LMWH) or unfractionated
heparin (UFH) plus long-term management with LMWH, vitamin K antagonists, or
direct oral anticoagulants. The acute VTE with malignancy requires initial
anticoagulation therapy for 5-10 days, LMWH is the medication of choice unless
contraindicated. The patient characteristics such as renal function, compliance, diet
adherence determine drug selection. Fondaparinux and direct oral anticoagulants can
also be initial treatment choices. UFH is preferred if a rapid anticoagulation reversal is
required in circumstances such as renal disease, high bleeding risk, and for patients
undergoing procedures. The factor Xa inhibitors are currently approved for initial DVT
and acute PE treatment. They eliminate the need to monitor anticoagulation
effectiveness. For those who are poor candidates for long-term LMWH, indirect oral
anticoagulant (warfarin) is acceptable for chronic management. DOACs can be an
alternative for those unable to use LMWH for reasons such as renal impairment
(creatinine clearance less than 30mL/min), cost, non-compliance, or fear of needles.
The duration of anticoagulation treatment is a minimum of 3 months. For those with
malignancy and VTE with contraindications to anticoagulants, the only therapeutic
option can sometimes be mechanical devices such as inferior vena cava filter (IVCF).
Keywords: Acute VTE, Cancer-associated thrombosis, Chronic anticoagulant
malignancy, IVC filter, LMWH in malignancy, Management of VTE in
malignancy, Oral anticoagulants, Rivaroxaban, Thrombosis in malignancy.
