[Management of Venous Thromboembolism in Cancer Patients]

The clinical relevance of the association between venous thromboembolism(VTE)and cancer is well documented. VTE is one of the leading causes of death in cancer patients. It would be an advantage to have knowledge on predictive parameters for the development of thrombosis and to be able to select cancer patients individually according to their riskprofiles. An elevated platelet count is associated with an increased riskof VTE in cancer patients. The biomarkers including D-dimer have been identified and used to extend the existing riskstratification. Treatment of VTE in cancer patients is complicated due to a high rate of recurrence in addition to a higher riskof bleeding during anticoagulation therapy. Current guidelines recommend low-molecular-weight heparin(LMWH)monotherapy over vitamin K antagonist(VKA)for the treatment of cancer-associated VTE. However, recent clinical study could not show any superior efficacy of LMWH over VKA in preventing VTE recurrence or overall mortality. The direct oral anticoagulants(DOACs)may be an effective treatment for VTE in cancer patients, although the riskreduction for recurrent VTE with the DOACs compared to LMWH has not been well assessed. Physicians should frequently re-evaluate the risk-benefit ratio of ongoing anticoagulation therapy in individual patient, in views of the overall clinical conditions including their quality of life and life expectancy.