No shots needed: direct oral anticoagulants in cancer-associated thrombosis—10-year follow-up

Active malignancy is a known prothrombotic state, first described by Armand Trousseau as thrombophlebitis occurring in a patient with metastatic gastric cancer. The most common presentation of cancer-associated thrombosis (CAT) is venous thromboembolism, inclusive of deep venous thrombosis and pulmonary embolism. With advances in survival of many cancers, the incidence of CAT is increasing, and an estimated 15% to 20% of all patients with cancer will experience venous thromboembolism during their treatment. Consequently, management and prevention strategies for CAT are paramount for comprehensive clinical care of patients with active malignancy. Direct oral anticoagulants, which have fixed drug dosing, few drug-drug interactions, lack of monitoring requirements, and ease of oral administration, have emerged as the preferred option for CAT, with significant clinical trial data supporting their use. Here, we review the current treatment and prevention paradigms for patients with CAT, the specific role of direct oral anticoagulants for CAT, and ongoing challenges in CAT treatment.