There is evidence of an important reduction in recurrent VTE in cancer patients given LMWH compared to those given warfarin27. In addition, INR control is often more difficult in patients receiving chemotherapy.
There is increasing evidence to support the use of DOACs in patients with active cancer.
Decisions on choice of anticoagulant should be made in conjunction with the patients oncology team.
After 6 months, the decision to continue anticoagulation should be discussed with the patient in light of ongoing risks and benefits. Current recommendations suggest anticoagulation should be continued beyond 6 months if the malignancy is still present, unless there are contra-indications to anticoagulation. There are many nuances to both the decision to continue anticoagulation and the dose to provide. These decisions should be discussed with the patient by a person with expertise in the area.