Author + information
- Received August 15, 2018
- Revision received January 2, 2019
- Accepted January 3, 2019
- Published online March 18, 2019.
- Ramya C. Mosarla, MDa,∗,
- Muthiah Vaduganathan, MD, MPHb,∗@mvaduganathan,
- Arman Qamar, MDc@AqamarMD,
- Javid Moslehi, MDd,
- Gregory Piazza, MD, MSb and
- Robert P. Giugliano, MD, SMc,∗ (, )@CardioOncology@rgiugliano
- aDepartment of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- bBrigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
- cTIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- dCardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- ↵∗Address for correspondence:
Dr. Robert P. Giugliano, TIMI Study Group, Brigham and Women’s Hospital, 60 Fenwood Avenue, Suite 7022, Boston, Massachusetts 02115.
• Patients with active cancer face higher risks of arterial and venous thromboembolism (VTE), atrial arrhythmias, and bleeding events.
• Historically, in patients with cancer, low-molecular weight heparins have been preferred for treatment of VTE, while warfarin has been the standard anticoagulant for stroke prevention in atrial fibrillation.
• Select direct oral anticoagulants have now been shown to safely prevent thrombotic events in recent clinical trials, and present an attractive oral dosing option for patients with cancer.
• Multidisciplinary care that accounts for individualized bleeding and thrombotic risks, drug-drug interactions, patient preferences, and periodic clinical reassessment is warranted to identify the optimal anticoagulation strategy for patients with cancer.
Patients with active cancer are at an increased risk of arterial and venous thromboembolism (VTE) and bleeding events. Historically, in patients with cancer, low molecular weight heparins have been preferred for treatment of VTE, whereas warfarin has been the standard anticoagulant for stroke prevention in patients with atrial fibrillation (AF). More recently, direct oral anticoagulants (DOACs) have been demonstrated to reduce the risk of venous and arterial thromboembolism in large randomized clinical trials of patients with VTE and AF, respectively, thus providing an attractive oral dosing option that does not require routine laboratory monitoring. In this review, we summarize available clinical trial data and guideline recommendations, and outline a practical approach to anticoagulation management of VTE and AF in cancer.
↵∗ Drs. Mosarla and Vaduganathan contributed equally as co-first authors.
Dr. Vaduganathan has received support from the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (National Institutes of Health/National Center for Advancing Translational Sciences Award UL 1TR002541); and has served on the advisory boards for Amgen, AstraZeneca, Bayer AG, and Baxter Healthcare. Dr. Qamar has received support from a National Heart, Lung, and Blood Institute T32 postdoctoral training grant (T32HL007604) and the American Heart Association Strategically Focused Research Network in Vascular Disease grants (18SFRN3390085 and 18SFRN33960262). Dr. Moslehi serves as a consultant or in an advisory role for Bristol-Myers Squibb, Daiichi-Sankyo, Novartis, Pfizer, Regeneron, Takeda, Myokardia, and Ipsen; and has received research funding from the NIH (R56 HL141466), Bristol-Myers Squibb, and Pfizer. Dr. Piazza has received research grant support from EKOS, a BTG International group company, Bristol-Myers Squibb, Daiichi-Sankyo, Bayer, Portola, and Janssen. Dr. Giugliano has received research grants and honoraria for CME programs from Daiichi-Sankyo and the American College of Cardiology; and has served as a compensated consultant for Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Janssen, Merck, Portola, and Pfizer. Dr. Mosarla has reported that she has no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received August 15, 2018.
- Revision received January 2, 2019.
- Accepted January 3, 2019.
- 2019 American College of Cardiology Foundation
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