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Anticoagulants in hematologic malignancies: what is the data?
Ruah Alyamany1, Damon E Houghton1,2
1Section of Classical Hematology, Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Hematology. American Society of Hematology. Education Program
|December 5, 2025
Summary
Patients with hematologic malignancies face a high risk of venous thromboembolism (VTE). This review addresses challenges and strategies for anticoagulation in these patients, excluding myeloproliferative neoplasms.
Area of Science:
- Hematology
- Oncology
- Vascular Medicine
Background:
- Hematologic malignancies significantly elevate venous thromboembolism (VTE) risk, particularly aggressive lymphomas and multiple myeloma.
- Current VTE risk scores show limited performance in hematologic malignancy patients.
- Thrombocytopenia and coagulopathies present unique challenges for VTE prevention and treatment.
Purpose of the Study:
- To review current evidence on anticoagulation strategies for patients with hematologic malignancies.
- To outline the key clinical challenges in managing VTE in this population.
- To propose practical strategies for guiding anticoagulation decisions.
Main Methods:
- Systematic literature review of anticoagulation in hematologic malignancies (excluding myeloproliferative neoplasms).
- Synthesis of evidence regarding VTE risk, prevention, and treatment.
- Analysis of clinical challenges and proposed management strategies.
Main Results:
- Anticoagulation is complex due to bleeding risks and disease-specific factors.
- Suboptimal performance of existing VTE risk stratification tools noted.
- Need for tailored approaches to anticoagulation is highlighted.
Conclusions:
- Effective anticoagulation in hematologic malignancies requires careful consideration of individual patient factors.
- Further research is needed to optimize VTE prevention and management strategies.
- Practical guidance is proposed to aid clinical decision-making in this high-risk group.
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