Updated review on malignancy-associated venous thromboembolism: Pathogenesis and comparison between various therapeutic modalities

Elmukhtar Habas¹, Ala Habas², Amnna Rayani³, Kalifa Farfar⁴, Eshark Habas⁵, Jamal Alfitori¹, Mehdi Arrayes¹, Aml Habas⁶, Abdel-Monem Badawi Yousif⁷, Abdel-Naser Elzouk¹

Keywords: Anticoagulation in malignancy, Cancer and direct oral anticoagulant, Low molecular weight heparin in malignancy, Venous thromboembolism in cancer, Vitamin K antagonist in cancer, Warfarin in malignancy

DOI: 10.32677/yjm.v3i1.4547

DOI URL: https://doi.org/10.32677/yjm.v3i1.4547

Publish Date: 11-05-2024

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Pages: 4 - 20

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Author Affiliation:

¹Senior Consultant, Department of Medicine
²Medical Student
³Senior Consultant, Department of Pediatrics, Tripoli Central Hospital
⁴Senior Consultant, Department of Medicine, Al Wakra Hospital, Al Wakrah, Qatar
⁵Medical Resident, Department of Medicine
⁶Medical Researcher, Department of Pediatrics, Pediatric Hospital, Tripoli, Libya
⁷Pharmacist, Department of Pharmacy, Hamad General Hospital, Doha, Qatar

Abstract

Venous thromboembolism (VTE) is one of the life-threatening complications in cancer patients, the incidence of which is affected by the patient and malignancy-related variables. Location, type, therapeutic route, stage, grade, and non-supportive treatment of the cancer are the most important VTE risk factors. Patient age, ethnicity, and concomitant genetic or acquired comorbidities or thrombophilias are known risk factors for VTE in cancer. All high-risk cancer patients admitted to hospitals or treated as outpatients should receive VTE prophylaxis. Low molecular weight heparin (LMWH) is the main treatment for active malignant VTE. Vitamin K antagonists and non-vitamin K-dependent oral anticoagulants are used in stable, nonbleeding cancer patients. Anticoagulation should be continued until the cancer is treated or at least controlled. Over the past two decades, randomized clinical and observational trials have improved the pathogenesis and therapeutic knowledge of VTE, but many challenges remain. The lack of an optimal primary prophylaxis method for inpatients and outpatients in oncology and the care of cancer-associated VTE in standard and high-bleeding risk groups are examples for which more clinical research on cancer-associated thrombosis is necessary to address these issues. In this review, we describe the pathogenesis, factors that increase the risk of VTE, and the comparison between the effectiveness of available anticoagulants in the treatment and prevention of VTE in cancer patients.

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