The current status and future perspective of extended anticoagulation therapy for cancer-associated venous thromboembolism

Cancer-associated venous thromboembolism (VTE) is one of important complications in cancer patients, with implications for morbidity, mortality, recurrent VTE, bleeding events, and quality of life. Extended anticoagulation therapy beyond 3-6 months of mandatory duration of anticoagulation therapy following an episode of VTE has been an unsolved issue in the management of patients with VTE. The current guidelines recommend extended anticoagulation therapy for patients with cancer-associated VTE because these patients could be at a high risk of recurrent VTE. However, patients with cancer-associated VTE are also at a high risk of bleeding events with anticoagulation therapy, which provoking dilemma taking a good balance between thrombotic and bleeding risk with extended anticoagulation therapy in the daily clinical practice. Thus, whether to extend anticoagulation therapy, which anticoagulants to use, what dosages of anticoagulants to take, and how long to extend the duration of anticoagulation therapy have been still a matter of active debate in these patients. So far, several studies including randomized clinical trials (RCT) have provided several insights into the optimal duration and dosage of extended anticoagulation therapy. Although recent RCTs significantly progress the understanding of extended anticoagulation therapy for cancer-associated VTE, there has been still a number of unmet needs in these patients. In the future perspective, a personalized approach that takes into account multiple factors could be needed for the optimal implementation of extended anticoagulation therapy in an individual patient with cancer-associated VTE. The current review overviews the current status and future perspective of extended anticoagulation therapy for cancer-associated VTE.