Anticoagulantes Orais Diretos No Tromboembolismo Venoso Associado Ao Câncer: Revisão Integrativa Sobre Implicações Clínicas
Year: 2026
Type: article
Study design: Systematic Review
Abstract: Venous thromboembolism (VTE) is the second leading cause of morbidity and mortality among cancer patients and is frequent in emergency care settings. In this context, direct oral anticoagulants (DOACs) emerge as an alternative to low-molecular-weight heparins (LMWHs), although concerns remain regarding their efficacy and safety in patients with active malignancies. This study aimed to analyze and synthesize scientific evidence on the use of DOACs in the management of cancer-associated VTE. An integrative literature review was conducted following PRISMA guidelines, searching PubMed and the Virtual Health Library (VHL) databases using the descriptors “Neoplasms,” “Anticoagulants,” and “Emergency,” combined with AND. After independent screening on the Rayyan platform, 15 original articles (2021-2026) in Portuguese, English, and Spanish were included. Results demonstrated that DOACs are non-inferior to LMWHs in preventing VTE recurrence, showing a 33% relative risk reduction (RR 0.67). Apixaban stood out for its safety profile, including in patients with moderate renal impairment. The Caravaggio Score showed excellent predictive performance (98% negative predictive value) for low risk. The main adverse event was an increased risk of gastrointestinal and genitourinary bleeding in cancers with high hemorrhagic potential, where LMWH remains preferred. Reversal agents (idarucizumab, andexanet alfa) enhance safety, although andexanet is unavailable in the SUS. In conclusion, DOACs have become a first-line strategy, offering better adherence and convenience, but require individual bleeding risk assessment, interaction monitoring, and attention to SUS limitations. Additionally, there is a lack of national studies regarding emergency management.
Institution: Universidade Estadual de Feira de Santana
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7203503746