Alvin H. Schmaier, MD, professor in the Department of Medicine and the Department of Pathology at Case Western Reserve University School of Medicine, discusses the management of patients with cancer-associated thrombosis.

The oral anticoagulants, Xa inhibitors can be given as prophylaxis or treatment for patients with cancer-associated thrombosis, explains Schmaier. These agents are given daily without injections or monitoring as primary therapy. The data suggest that these agents have improved safety compared with prior anticoagulants without compromising efficacy.

It is important to recognize that the management of thrombosis should be an adjunct to the patient’s cancer treatment. Data suggest that patients who experience thrombosis within the first year of their cancer diagnosis have a 66% mortality rate. Ignoring the management of thrombosis can compound that risk and compromise the patient’s initial cancer treatment, concludes Schmaier.

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Dr. Schmaier on Managing Cancer-Associated Thrombosis

Alvin H. Schmaier, MD, professor in the Department of Medicine and the Department of Pathology at Case Western Reserve University School of Medicine, discusses the secondary management of thrombosis in patients with hematologic malignancies.

The goal of secondary management is to ensure the patient does not have excess bleeding, says Schmaier.

In May 2018, the FDA granted an accelerated approval to the coagulation factor Xa antidote andexanet alfa (Andexxa) for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis). The drug is indicated for patients who need to reverse anticoagulation due to life-threatening or uncontrolled bleeding.

While the agent has not been studied in a randomized clinical trial, its approval has helped fulfill an unmet clinical need in this space.

Prothrombin complex concentrates are also available agents for these patients, explains Schmaier. Though these agents have not been FDA approved, multinational clinical trials have demonstrated their efficacy, and they are considered the standard of care in this space.

Alvin H. Schmaier, MD, discusses the secondary management of thrombosis in patients with hematologic malignancies.



Dr. Schmaier on the Secondary Management of Thrombosis in Hematologic Malignancies

Alvin H. Schmaier, MD, professor in the Department of Medicine and the Department of Pathology at Case Western Reserve University School of Medicine, discusses managing thrombosis in patients with hematologic malignancies.

Cancer-associated thrombosis (CAT) is a known cause of morbidity in patients with hematologic malignancies. However, evidence-based data regarding CAT has led to the development of novel prophylactic and therapeutic treatments for patients, says Schmaier.

This data has informed CAT prevention and management, as well as secondary management for patients who have already received CAT treatment, explains Schmaier.

Novel anticoagulant agents have expanded the treatment paradigm and allowed for better adjunctive treatment of patients with cancer, concludes Schmaier.

Alvin H. Schmaier, MD, discusses managing thrombosis in patients with hematologic malignancies. 

Alvin H. Schmaier, MD

Articles

Dr. Schmaier on Managing Cancer-Associated Thrombosis

Dr. Schmaier on the Secondary Management of Thrombosis in Hematologic Malignancies

Dr. Schmaier on Managing Thrombosis in Hematologic Malignancies