Anticoagulation for cancer-associated thromboembolism

We interview Dr. Sang-A Kim regarding the article entitled "Treatment and bleeding complications of cancer-associated venous thromboembolism: A Korean population-based study" published in Thrombosis and Haemostasis (https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1886-5991)

Why did you (and your colleagues) write this paper? What was its main purpose?

Currently, major guidelines support the use of direct oral anticoagulants (DOACs) in cancer-associated thromboembolism (CAT). However, bleeding complications, particularly gastrointestinal bleeding, are major obstacles to the use of DOACs. Therefore, special caution is required in the use of DOACs in patients with gastrointestinal cancers.

Unfortunately, major clinical trials conducted to date do not provide sufficient answers to this problem. Considering the fact that Asian countries including Korea show a higher prevalence of upper gastrointestinal cancers compared with western countries, we aimed to analyze treatment patterns and bleeding complications of CAT in Asian patients.

What are the main conclusions?

Five years after their introduction into clinical practice, DOACs have become the most prescribed anticoagulant in CAT patients in Korea. In CAT patients, bleeding complications were more common with DOACs than parenteral anticoagulants. In addition, the difference was more apparent in patients with gastrointestinal cancers.

What are the paper's implications?- to the public?-to medical professionals?

Our nationwide population-based study suggests that personalized anticoagulation and cautious monitoring for bleeding are required for optimal treatment of CAT. In patients with gastrointestinal cancers, the risk of bleeding should be considered especially carefully. For patients who want to have a shared discussion with their doctor about their CAT treatment, I think this information can also be helpful in decision making.

Are the findings clinically significant? Should the findings change practice??

The conclusion of our study further reinforces existing guidelines for caution in the use of DOACs in patients with gastrointestinal cancer. However, there is still no clear guidance on the modification of drug dose or monitoring of such patients. We believe that further research is warranted in these areas.