Evaluating DDIs in cancer patients receiving anticoagulants and antineoplastics: a scoping review focusing on therapeutic efficacy and safety.

Abstract

Cancer-associated thrombosis (CAT) has become increasingly important due to its prevalence and impact on patient outcomes. The risk of venous thromboembolism (VTE) is significantly increased during cancer progression and cancer therapy, highlighting the urgent need for effective anticoagulant strategies. There are several categories of anticoagulants, the most important being low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs). Investigating drug-drug interactions (DDIs) of these anticoagulants with oncology drugs is crucial to ensure effective and safe treatment options for cancer patients. Using a comprehensive search strategy, the PubMed and Embase databases were used to identify studies reporting DDIs between anticoagulants and antineoplastic drugs through December 2023. Four studies met the inclusion criteria and included 299 patients, mostly women, with different comorbidities and treatment regimens for anti-thrombotic and anti-neoplastic therapy. Studies have reported varying degrees of severity of DDIs, ranging from no interaction to contraindicated interactions, which affect the efficacy and safety results of the treatment, such as bleeding and thrombotic events. Compared to DOACs, LMWHs does not interact with chemotherapy drugs. While LMWHs is preferred due to its predictable response and minimal toxicity, DOACs are a more appropriate option despite concerns regarding their interaction with oncological drugs. Understanding and managing DDIs between anticoagulant medications and oncology drugs is critical to optimising treatment outcomes for cancer patients. Further studies are needed to elucidate the clinical implications of these interactions and guide therapeutic decisions in this complex patient population.