[Treatment of cancer associated thrombosis].
Research article published in La Revue du praticien (2022)
Abstract
"Treatment of cancer associated thrombosis The treatment of cancer-associated venous thromboembolic disease is complex due to an increased risk of thrombotic recurrence and bleeding under treatment. During the first 6 months, low molecular weight heparins are more effective than vitamin k antagonists without increasing the risk of bleeding. Direct oral anticoagulants (doacs) have at least comparable efficacy to delateparin. The hemorrhagic risk of doacs is comparable or higher than that of dalteparin, but seems to depend on the doac studied and, at least for some of them, on the location of the tumor. Beyond the 6th month, the cura-tive anticoagulant treatment is continued as long as the cancer is active with low molecular weight heparin if it is well tolerated and effective or by using a doac at full dose while waiting for the results of a randomized trial comparing the efficacy and safety of half-dose versus full-dose of apixaban." "Traitement de la maladie thromboembolique veineuse associée au cancer Le traitement de la maladie thromboembolique veineuse associée au cancer est plus complexe du ait de l’augmentation du risque de récidive thrombotique et d’hémorragie sous traitement. Au cours des six premiers mois, les héparines de bas poids moléculaire sont plus efficaces que les antivitamine-k sans augmentation du risque hémorragique. Versus la daltéparine, l’efficacité des anticoagulants oraux directs (aod) est au moins comparable. Le risque hémorragique lié aux aod est comparable ou supérieur à celui de la daltéparine, mais semble dépendre de l’aod étudié et, au moins pour certains d’entre eux, de la localisation de la maladie tumorale. Au-delà du sixième mois, le traitement anticoagulant curatif est poursuivi tant que le cancer est actif, avec l’héparine de bas poids moléculaire si elle est bien tolérée et efficace, ou un anticoagulant oral direct à pleine dose, en attendant les résultats d’un essai randomisé en cours comparant l’efficacité et la tolérance de l’apixaban à demi-dose et à pleine dose."
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
"Treatment of cancer associated thrombosis The treatment of cancer-associated venous thromboembolic disease is complex due to an increased risk of thrombotic recurrence and bleeding under treatment. During the first 6 months, low molecular weight heparins are more effective than vitamin k antagonists without increasing the risk of bleeding.
Why This Matters for Hirudotherapy
This review of cancer-associated venous thromboembolism describes a population at elevated risk of both recurrent thrombosis and treatment-related bleeding, summarizing that during the first 6 months low-molecular-weight heparins are more effective than vitamin-K antagonists without increasing bleeding, that direct oral anticoagulants offer at least comparable efficacy to dalteparin with bleeding risk that is comparable or higher and varies by agent and tumor location, and that beyond 6 months anticoagulation continues while the cancer is active (LMWH if tolerated and effective, or a full-dose DOAC), with a randomized trial comparing half-dose versus full-dose apixaban awaited. For the ASH clinical-evidence picture it frames the difficult thrombosis-bleeding trade-off in oncology patients, exactly the kind of complex coagulation context in which any adjunctive procedure with bleeding potential, including hirudotherapy, would require careful caution, and it situates the anticoagulant drug classes against which leech-derived thrombin inhibitors are conceptually compared. Caveat: this is a narrative clinical review of pharmacologic anticoagulation, not original data and not a study of leeches or hirudotherapy, so it provides only background safety and evidence context.
Citation
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