Oral Anticoagulants Make Welcome Addition to VTE Patient Care

Andrew D. Smith
Published: Thursday, May 10, 2018
Michael B. Streiff, MD

Michael B. Streiff, MD
The standard of care for patients with cancer who suffer dangerous blood clots has been painful and expensive daily injections with unfractionated or low-molecular-weight heparin (LMWH). Now clinical trial findings published in the New England Journal of Medicine1 have helped convince a National Comprehensive Cancer Network (NCCN) panel to make a change. The guideline committee has designated a direct oral anticoagulant (DOAC) as a preferred frontline treatment for most patients with cancer-associated venous thromboembolism (VTE).2

Clinical Trial Findings

The Hokusai VTE Cancer trial, which helped pave the way for the guideline change, was designed as a noninferiority study for patients with cancer who had acute symptomatic or incidental VTE, including deep-vein thrombosis (DVT), acute symptomatic pulmonary embolism (PE), or incidentally detected PE. Patients received a lead-in therapeutic dose of LWMH for at least 5 days and were then randomized to edoxaban or dalteparin (Fragmin), an LMWH. Edoxaban was administered orally at 60 mg daily with or without food, and dalteparin was given subcutaneously at 200 IU/kg daily for 1 month followed by 150 IU/kg daily.1


Table. NCCN Recommendations for Anticoagulant Therapy for VTE2

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