Venous Thromboembolism Management and Anticoagulation Opportunities in Cancer Patients.

Abstract

Cancer predisposes to venous thromboembolic complications, especially at the moment of diagnosis, and anticoagulation may be less effective. Additionally, some cancers, especially in the gastrointestinal tract or the genitourinary system, may be associated with an extremely high risk of bleeding. Anticoagulant treatment in venous thromboembolism associated with cancer is characterised by significant differences compared with the general cardiology population. It is necessary to choose the appropriate anticoagulation, either a new non-vitamin K antagonist oral anticoagulant or low-molecular-weight heparin. The efficacy and safety are determined by characteristics of the cancer and anticancer therapy. The duration of anticoagulation determines not only the choice of anticoagulant, but also the dose. There is some evidence to justify the reduction of anticoagulant dosage after 6 months of treatment. In active cancer, it is worth continuing anticoagulation indefinitely, but this does not necessarily mean for the rest of a patient's life. It is important to repeat an assessment when the risk of bleeding outweighs the benefits.