The Newer Anticoagulants in Thrombosis Control in Cancer Patients

Cancer and hemostasis are strongly correlated and the development of venous thromboembolism (VTE) has a major adverse impact on the outcome of cancer patients. Treatment of cancer-associated VTE is far more challenging than treating VTE in the non-cancer population, as the clinical course of cancer patients is characterized by increased rates of both recurrent thromboembolic episodes and bleeding complications. This has led to the development of a distinct management approach towards VTE in patients with active cancer. Low-molecular-weight heparins (LMWHs) currently represent the therapeutic agent of choice, as a result of a proven higher efficacy compared to vitamin K antagonists (VKAs). However, as LMWHs require daily subcutaneous injections, weight-adjusted doses, and still confers high risks of recurrent VTE and bleeding complications, management of cancer-associated VTE warrants further optimization. In recent years several novel, target-specific oral anticoagulants have been introduced and evaluated in clinical trials. These new anticoagulants display several advantages compared to conventional anticoagulants. This review will evaluate their trial results up-to-date with a particular focus on the cancer patients included in these trials. The potential of these agents in the setting of cancer-associated VTE will be discussed and directions for future research will be provided.