Direct oral anticoagulants in gastrointestinal malignancies: is the convenience worth the risk?

Venous thromboembolic disease (VTE) is a common cause of morbidity and mortality in patients with cancer. The landmark CLOT trial demonstrated low-molecular-weight heparin’s (LMWH) superiority to vitamin K antagonists for treatment of established VTE in cancer patients (1). LMWH has therefore been endorsed by major guidelines for cancer-associated thrombosis (CAT) for over a decade. However, several aspects of LMWH render it non-ideal for this indication, including its parenteral administration, renal clearance, relatively high cost, and an approximately 8% breakthrough thrombosis rate (1)