Review Series CANCER-ASSOCIATED THROMBOTIC DISEASE Treatment of cancer-associated thrombosis

Therapeutic options for the management of venous thromboembolism (VTE) in patients with cancer remain very limited. Although low-molecular-weight heparin monotherapy has been identified as a simple and efficacious regimen compared with an initial parenteral anticoagulant followed by long-term therapy with a vita-min K antagonist, many clinical questions remain unanswered. These include optimal duration of anticoagulant therapy, treatment of recurrent VTE, and the treatment of patients with concurrent bleeding or those with a high risk of bleeding. Treatment rec-ommendations from consensus clinical guidelines are largely based on retrospec-tive reports or extrapolated data from the noncancer population with VTE, as ran-domized controlled trials focused on cancer-associated thrombosis are sorely lacking. Furthermore, with improvements in imaging technology and extended survival duration of patients with cancer, we are encountering more unique chal-lenges, such as the management of in-cidental VTE. Clinicians should be aware of the limitations of the novel oral anti-coagulants and avoid the use of these agents because of the paucity of evidence in the treatment of cancer-associated thrombosis. (Blood. 2013;122(14):2310-2317