https://scholars.lib.ntu.edu.tw/handle/123456789/641699
標題: | Safe and effective treatment of venous Thromboembolism associated with Cancer: focus on direct Oral Anticoagulants in Asian patients | 作者: | Lee, Lai Heng Danchaivijitr, Pongwut Uaprasert, Noppacharn Gill, Harinder Sacdalan, Dennis Lee Ho, Gwo Fuang Parakh, Rajiv Pai, Paresh JEN-KUANG LEE Rey, Nannette Cohen, Alexander T |
關鍵字: | Anticoagulation; Cancer; Venous Thromboembolism | 公開日期: | 27-十月-2022 | 卷: | 11 | 期: | 1 | 來源出版物: | Experimental hematology & oncology | 摘要: | Cancer-associated thrombosis (CAT) poses a significant disease burden and the incidence in Asian populations is increasing. Anticoagulation is the cornerstone of treatment, but can be challenging due to the high bleeding risk in some cancers and the high risk of recurrent venous thromboembolism (VTE) in patients with malignancies. Direct oral anticoagulants (DOACs) are well established as first-choice treatments for VTE in non-cancer patients, offering a more convenient and less invasive treatment option than low-molecular-weight heparin (LMWH). Asian patients have exhibited comparable efficacy and safety outcomes with other races in trials of DOACs for VTE in the general population. Although no specific data are available in Asian patients with CAT, results from randomized controlled trials of apixaban, edoxaban, or rivaroxaban versus the LMWH, dalteparin, indicate that DOACs are a reasonable alternative to LMWH for anticoagulation in Asian patients with CAT. This is further supported by analyses of real-world data in Asian populations demonstrating the efficacy and safety of DOACs in Asian patients with CAT. Apixaban, edoxaban, or rivaroxaban are recommended in the most recently updated international guidelines as first-line therapy for CAT in patients without gastrointestinal or genitourinary cancers and at low risk of bleeding. An increased risk of major gastrointestinal bleeding was evident with edoxaban or rivaroxaban, but not apixaban, versus dalteparin in the clinical trials, suggesting that apixaban could be a safe alternative to LMWH in patients with gastrointestinal malignancies. Determining the optimal anticoagulant therapy for patients with CAT requires careful consideration of bleeding risk, tumor type, renal function, drug-drug interactions, financial costs, and patients' needs and preferences. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/641699 | ISSN: | 2162-3619 | DOI: | 10.1186/s40164-022-00331-9 |
顯示於: | 醫學系 |
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