Anticoagulation UK

01 July 2019

Oral anticoagulation is preferable to injected, but only if it is safe and effective: An interview study of patient and carer experience of oral and injected anticoagulant therapy for cancer-associated thrombosis in the select-d trial

Cancer-associated thrombosis is the second highest preventable cause of cancer mortality, with the greatest risk of death in the first 3 months of diagnosis. Distressing complications, such as venous thromboembolism recurrence and bleeding, are also more common among cancer patients. It is associated with significant symptoms and clinicians find it challenging to diagnose and treat, particularly in advanced disease.

Clinical guidelines for cancer-associated thrombosis recommend 3–6 months of daily subcutaneous injection
of low-molecular-weight heparin; there is a 50% relative risk reduction in recurrent venous thromboembolism with low-molecular-weight heparin compared to vitamin K antagonists, without an increase in bleeding. Direct oral anticoagulants are currently recommended in guidelines for the cancer population only if low-molecularweight heparin is not tolerated.