Solid cancers after antiplatelet therapy: Confirmations, controversies, and challenges

Area of Science:

• Oncology
• Pharmacology
• Cardiovascular Medicine

Background:

• The association between anticoagulants, antiplatelet agents, and cancer is under investigation.
• Existing data suggest a complex relationship, potentially involving direct drug effects, tumor growth promotion, or enhanced metastasis.

Purpose of the Study:

• To investigate the role of anticoagulants and antiplatelet agents in tumor growth and prognosis.
• To analyze the class effect of antithrombotic agents on solid cancer risks.

Main Methods:

• Review of randomized clinical trial data, including TRITON, TRACER, DAPT, PEGASUS, PLATO, and TRA2P.
• Analysis of FDA reviews and reported cancer-related adverse events associated with various antithrombotic medications.

Main Results:

• Randomized evidence suggests a class effect of antithrombotic agents on cancer risk, not specific to individual drugs.
• Increased solid cancer incidence observed with prasugrel, vorapaxar, clopidogrel, and ticagrelor, particularly with longer durations or aggressive regimens.

Conclusions:

• Antithrombotic therapy, especially dual oral antiplatelet therapy (DAPT) exceeding two years or aggressive regimens, is associated with an increased risk of solid cancers.
• Current evidence supports more cautious platelet inhibition and shorter exposure to dual oral antiplatelet agents to minimize cancer-related risks.