Role of direct oral anticoagulants in gastrointestinal cancer associated thrombosis “practical issues in clinical practice”—narrative review

Objective: Direct oral anticoagulants (DOAC) are now considered an effective treatment option for cancer associated thrombosis (CAT). There are still controversies in the use of DOACs in CAT associated with gastrointestinal (GI) malignancies. Background: Patients with GI malignancies and CAT present several unique management challenges. Factors such as the risk of bleeding from intact luminal primary, impact on absorption and efficacy of the DOACs due to altered anatomy, chemotherapy-induced nausea and vomiting, the potential drug to drug interactions need to be considered when prescribing DOACs in CAT associated with GI malignancies. Methods: The landmark randomised controlled trials (RCTs), systematic reviews and observational studies (OSs) of real-world data comparing DOACs with low molecular weight heparin (LMWH) in treating CAT comprised heterogeneous groups of tumour sites with limited numbers of patients with GI malignancies. This article reviews the available evidence on outcomes of the subset of CAT associated with GI malignancies in recent RCTs. Conclusions: Future prospective trials need to evaluate the impact of the factors mentioned above in the efficacy of DOACs in preventing and treating CATs in specific subsets of GI malignancies. Until more evidence is available, LMWH is a more reasonable choice in selected subgroups of CAT in GI malignancies.