John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Gastro-intestinal cancers and thrombosis: A new place for direct oral anticoagulants? Volume 29, issue 2, February 2022

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Authors
1 CHU Rennes, Hôpital Sud, Service de médecine interne et d’immunologie clinique, 16 boulevard de Bulgarie, 35203 Rennes Cedex 2 - BP 90347
2 Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes
3 CHU Rennes, Laboratoire d’hémostase, Rennes
* Correspondance

The management of venous thromboembolic disease in cancer patients was the subject of French recommendations in 2019, updated in 2021. Anticoagulation can be done with low molecular weight heparin (LMWH), direct oral anticoagulant (DOA) or vitamin K antagonist (VKA). VKAs can be used when LMWHs are not available, particularly in cases of chronic end-stage renal disease. The CARAVAGGIO study comparing apixaban and dalteparin confirmed the non-inferiority of apixaban at 6 months of treatment in terms of venous thromboembolic recurrence and incidence of major bleeding. Therefore, it is recommended that patients with active cancer and a venous thromboembolic event be treated for at least six months with either LMWH without VKA therapy or with apixaban. After six months of anticoagulant treatment for a venous thromboembolic event in the context of cancer, it is recommended that anticoagulant treatment be continued when the cancer is active, with a reassessment of the indication every 6 months. It is suggested that LMWH or AOD should be continued when it is well tolerated, effective and well accepted by the patient, and that an oral anticoagulant, preferably an AOD rather than a VKA, should replace LMWH when LMWH treatment is poorly accepted or tolerated.