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Cancer-Associated Thrombosis
Declaration of sponsorship Pfizer and Bristol Myers Squibb

DOAC Treatments for CAT

Declaration of sponsorship Pfizer and Bristol Myers Squibb
Emerging evidence suggests that direct oral anticoagulants (DOACs) are promising new treatments for cancer-associated thrombosis (CAT), which may be more appropriate for certain subsets of cancer patients.

Major guidelines including the National Comprehensive Cancer Network (NCCN) 2018, American Society of Clinical Oncology (ASCO) 2019, International Society on Thrombosis and Haemostasis (ISTH) 2018 

and European Society of Cardiology (ESC) 2019 updates recommend the use of low molecular-weight heparin (LMWH) for the treatment of cancer-associated venous thromboembolism (VTE) and have recently added the use of direct oral anticoagulants (DOACs)  edoxaban or rivaroxaban1–5,6–8.

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There are several studies ongoing which assess the efficacy and safety of DOACs compared with LMWH in patients with cancer-associated VTE, including the randomised CASTA-DIVA (rivaroxaban), and CANVAS studies (Table 2)13,14.

Other ongoing studies

In addition, patient reported outcomes with rivaroxaban are under investigation in CONKO-011, a randomized open-label study which is part of the CALLISTO programme.16

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1. Farge, D. et al. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. The Lancet Oncology 2019;20:e566–e581

2. Key, N. S. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. Journal of Clinical Oncology 2020;38:496–520

3. Konstantinides, S. V. et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). European Heart Journal 2020;41:543–603

4. Streiff, M. B. et al. NCCN Guidelines® insights cancer-associated venous thromboembolic disease, version 2.2018 featured updates to the NCCN guidelines. JNCCN J. Natl. Compr. Cancer Netw. 2018;16:1289–1303

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