Fast Five Quiz: Cancer-Associated Venous Thromboembolism (VTE)

Kenneth A. Bauer, MD


March 17, 2020

Clinical guidelines recommend low-molecular-weight heparin (LMWH) for both short- and long-term management of cancer-associated VTE. This is different from how VTE is treated in patients without cancer, in whom vitamin K antagonists (VKAs) are a recommended option for long-term oral treatment of VTE after initial heparin treatment.

Patients with cancer are at increased risk of bleeding and potential drug-drug interactions with chemotherapy, which complicates the treatment of VTE in this population. Compared with patients without cancer, patients with cancer are at a threefold to fourfold higher risk for VTE recurrence, even when treated with a VKA, and are also subject to a sixfold higher risk for anticoagulant-associated bleeding. Plus, the vomiting induced by chemotherapy and drug-drug interactions between VKAs and anticancer medications inhibits oral anticoagulation. LMWH, on the other hand, is associated with similar or lower rates of VTE recurrence and bleeding compared with VKAs in patients with cancer-associated VTE, does not rely on gastrointestinal absorption, and has minimal interaction with chemotherapy agents.

Direct oral anticoagulants could potentially overcome some of the complications seen with VKAs and LMWH, such as bleeding, drug-drug interactions with chemotherapy, and inconvenience, and clinical data supporting their use in patients with cancer are becoming available.

Learn more about the treatment of cancer-associated VTE.


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