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1/ Tweetorial: DOACs in cancer
The risk of venous thromboembolism (VTE) is up to 7 x higher in patients with cancer, and contributes to morbidity and mortality
Overall prognosis is worse in patients with cancer and VTE, compared to those with cancer and no VTE
The risk of venous thromboembolism (VTE) is up to 7 x higher in patients with cancer, and contributes to morbidity and mortality
Overall prognosis is worse in patients with cancer and VTE, compared to those with cancer and no VTE
2/ The treatment of VTE in cancer is complex due to concerns around;
-Interactions with anti-cancer treatment
-Timing of surgery and procedures
(no scalpel emoji)
-Low platelet counts due to treatment
-Higher risk of bleeding related to some cancers
-Interactions with anti-cancer treatment
-Timing of surgery and procedures
(no scalpel emoji)-Low platelet counts due to treatment
-Higher risk of bleeding related to some cancers
3/ LMWH was traditionally the treatment of choice, with data from the CLOT study (2003) showing improved efficacy vs warfarin & no 
bleeding risk
It is a useful option as no monitoring (usually) required, less interactions and short T1/2. It is however given by injection...
bleeding riskIt is a useful option as no monitoring (usually) required, less interactions and short T1/2. It is however given by injection...
4/ Several studies have investigated DOAC use in cancer.
These showed;
Edoxaban (Hokusai VTE)-
VTE recurrence compared to LMWH. major bleeding, esp GI tract
Rivaroxaban (SELECT D)- VTE recurrence compared to LMWH. clinically relevant non-major bleeding
These showed;
Edoxaban (Hokusai VTE)-
VTE recurrence compared to LMWH. major bleeding, esp GI tractRivaroxaban (SELECT D)-
VTE recurrence compared to LMWH. clinically relevant non-major bleeding
5/
Apixaban (ADAM VTE and Caravaggio)- superior to LMWH for VTE recurrence with similar rates of major bleeding, except for a subgroup of patients over the age of 75 who had more with apixaban
Apixaban (ADAM VTE and Caravaggio)- superior to LMWH for VTE recurrence with similar rates of major bleeding, except for a subgroup of patients over the age of 75 who had more with apixaban
6/ A common concern in these studies was increased rates of bleeding, some major, in patients with GI/GU cancers on DOACs
The ISTH subsequently advised caution in using DOACs in patients with malignancies of the GI/GU tract
The ISTH subsequently advised caution in using DOACs in patients with malignancies of the GI/GU tract
7/ In summary, DOACs should be considered for many, but not all patients with cancer and VTE. Caution should be exercised in those with high bleeding risk (e.g. GI cancers) and elderly patients (> 75). As always, individualised decisions should be made with the patient’s input
8/ If you want to put some of this new knowledge into practice, our friends at @TeamHaem are running a case about DOACs in cancer
It’s like a Marvel crossover of the haematology Twitter world
It’s like a Marvel crossover of the haematology Twitter world
9/
#FOAMed #MedEd #MedTwitter #TipsForNewDocs
References:
https://theoncologist.onlinelibrary.wiley.com/doi/pdf/10.1002/onco.13584
https://ashpublications.org/blood/article/133/4/291/272766/How-I-treat-cancer-associated-venous
https://onlinelibrary.wiley.com/doi/pdf/10.1111/jth.14219
#FOAMed #MedEd #MedTwitter #TipsForNewDocs
References:
https://theoncologist.onlinelibrary.wiley.com/doi/pdf/10.1002/onco.13584
https://ashpublications.org/blood/article/133/4/291/272766/How-I-treat-cancer-associated-venous
https://onlinelibrary.wiley.com/doi/pdf/10.1111/jth.14219
