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Semin Thromb Hemost 2021; 47(08): 950-961
DOI: 10.1055/s-0041-1726298
Review Article

Single, Dual, and Triple Antithrombotic Therapy in Cancer Patients with Coronary Artery Disease: Searching for Evidence and Personalized Approaches

Ciro Santoro
1   Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
,
Valentina Capone
1   Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
,
Mario Enrico Canonico
1   Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
2   Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
,
Giuseppe Gargiulo
1   Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
,
Roberta Esposito
1   Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
,
Giuseppe Damiano Sanna
2   Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
,
Guido Parodi
2   Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
,
Giovanni Esposito
1   Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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Abstract

Improvement in life expectancy of patients suffering from oncohematologic disorders has turned cancer from an acute into a chronic condition, making the management of comorbidities problematic, especially when it comes to both acute and chronic cardiovascular diseases. Treatment-related adverse events and drug–drug interactions often influence the therapeutic approach of patients with active malignancies and cardiovascular disease. Furthermore, tumor cells and platelets maintain a complex crosstalk that on one hand enhances tumor dissemination and on the other hand induces hemostasis abnormalities. Hence, clinicians should move carefully in the intricate land mines established by patients with active cancer under antithrombotic therapy. To date, there is no consensus on the antithrombotic treatment of patients with cardiovascular diseases and concomitant malignancies. The aim of this review is to collect the available scientific evidence, including the latest clinical trials and guidelines, in order to provide guidance on the management of antithrombotic treatment (both antiplatelet and anticoagulant therapy) in cancer patients with either pre-existent or new-onset coronary artery disease. Randomized-controlled trials on antithrombotic treatment in oncologic populations, which by far have thus far been excluded, have to be promoted to supply recommendations in the oncohematologic setting.

Keywords

dual antiplatelet therapy - bleeding risk - coronary artery disease - anticoagulant therapy


Publication History

Article published online:
14 July 2021

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