Emerging Insights of Management of Venous Thromboembolism in Patients With Cancer.
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Cancer -associated thrombosis (CAT), particularly venous thromboembolism (VTE), is a major contributor to mortality in cancer patients and is widely recognized as a leading cause of death after the direct effects of cancer progression. Cancer patients have significantly higher VTE risk than the general population, due to hypercoagulable states and anticancer therapies, with those with advanced malignancies carrying the highest risk. Primary thromboprophylaxis and anticoagulation are pivotal for CAT management. Despite advances, key challenges include different thrombotic and bleeding risks across cancers and how recurrent VTE affects anticoagulation duration. Low-molecular-weight heparin (LMWH) has largely replaced warfarin, and direct oral anticoagulants (DOACs) are challenging LMWH's first-line role with proven efficacy. However, the key dilemma is balancing thromboprophylaxis and treatment against anticoagulant-induced bleeding, particularly in the context of recurrent VTE. Current CAT guidelines show discrepancies and gaps in clinical coverage; some conclusions derived from meta-analyses need validation via more randomized controlled trials. This review synthesizes recent CAT research (focused on VTE) across epidemiology, pathophysiology, laboratory assessments, and management. It analyzes how cancer type, patient conditions, and drug-drug interactions influence anticoagulant selection, supported by a review of the corresponding experimental evidence. Additionally, the article addresses key clinical scenarios (e.g., intracerebral hemorrhage, pregnancy, pediatric and adolescent patients, and COVID-19) to aid clinical decision-making, delineates unresolved clinical controversies, and integrates high-quality cohort/subgroup data to guide meta-analysis validation. By summarizing risk-benefit consideration, this article provides a framework for complex cases and informs future RCT design.