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General medicine
Optimal anticoagulant treatment of cancer-associated venous thromboembolism remains unclear
  1. Hanny Al-Samkari
  1. Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Hanny Al-Samkari, Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114, USA; hal-samkari{at}mgh.harvard.edu

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Commentary on: Kahale LA, Hakoum MB, Tsolakian IG, et al. Anticoagulation for the long-term treatment of venous thromboembolism in people with cancer. Cochrane Database Syst Rev. 2018;6:CD006650.

Context

Venous thromboembolism (VTE) complicates the course of 5%–10% of patients with cancer and remains the second leading cause of death in patients with cancer after the malignancy itself.1 Until recently, the standard-of-care treatment for cancer-associated VTE has been low molecular weight heparin (LMWH) for extended periods based on the results of several randomised controlled trials (RCT) comparing LMWH with vitamin K antagonists (VKA). As an injectable, expensive agent, adherence may be poor by both patients and providers.1 The direct oral anticoagulants (DOAC) are a new oral treatment option that does not require regular anticoagulant monitoring, and therefore an attractive potential alternative to LMWH and VKAs. Published evidence for the efficacy and safety of DOACs in comparison with LMWH is currently limited to two RCTs. This systematic review examines the …

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