Pharmacokinetic interactions between anticancer drugs and direct oral anticoagulants: clinical implications for safe anticoagulation

Patients with cancer have an increased risk of thrombosis requiring anticoagulation. Direct oral anticoagulants have become the primary anticoagulant of choice in most patients with cancer. Patients with cancer also receive many concomitant medications, including anticancer therapies with potential risks of drug-drug interactions with anticoagulants that can lead to concerns of bleeding or recurrent thrombosis. The best management strategies remain unclear. In this article, we aim to review the available literature pertaining to pharmacokinetic interactions between anticancer therapies and direct oral anticoagulants and provide guidance based on the evidence.