Venous Thromboembolism in Hematologic Malignancies: Incidence, Risk Factors, and the Role of Direct Oral Anticoagulants
- 1Department of Translational and Precision Medicine Sapienza University of Rome Rome Italy
Abstract
Thrombotic events, particularly venous thromboembolism (VTE), are a significant source of morbidity and mortality among patients with hematologic malignancies. These patients face unique challenges due to treatment‐related complications such as thrombocytopenia, coagulopathy, and heightened bleeding risk. Traditionally managed with low molecular weight heparin (LMWH), the advent of direct oral anticoagulants (DOACs) has introduced new opportunities for both prophylaxis and treatment of cancer‐associated thrombosis (CAT). This narrative review explores the disease‐specific thrombotic risk across hematologic malignancies and critically evaluates the current evidence supporting the use of DOACs in this setting. While emerging data suggest DOACs are effective and safe for VTE treatment and secondary prophylaxis, although with a higher incidence of clinically relevant non‐major bleeding in some studies, their role in primary prophylaxis remains under investigation and is currently limited by insufficient disease‐specific data. Laboratory monitoring may be warranted in the presence of anti‐cancer treatment‐DOACs interactions or unexpected clinical events. The utility of DOACs is particularly constrained in thrombocytopenic patients, where bleeding risks are heightened and evidence remains limited. Overall, this review highlights the need for robust, prospective, disease‐specific trials to define optimal anticoagulation strategies in oncohematologic patients and refine clinical decision‐making in this complex and high‐risk population.
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BibTeX
@article{biglietto2026venous,
title = {{Venous Thromboembolism in Hematologic Malignancies: Incidence, Risk Factors, and the Role of Direct Oral Anticoagulants}},
author = {Mario Biglietto and Silvia Sorella and Erminia Baldacci and Massimo Breccia and Sabina Chiaretti and Marcello Capriata and Livia Donzelli and Gianna Maria D'Elia and Salvatore Giacomo Morano and Ilaria Del Giudice and Maurizio Martelli and Cristina Santoro and Antonio Chistolini},
journal = {European Journal of Haematology},
year = {2026},
month = aug,
doi = {10.1111/ejh.70262},
url = {https://doi.org/10.1111/ejh.70262},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Venous Thromboembolism in Hematologic Malignancies: Incidence, Risk Factors, and the Role of Direct Oral Anticoagulants
AU - Mario Biglietto
AU - Silvia Sorella
AU - Erminia Baldacci
AU - Massimo Breccia
AU - Sabina Chiaretti
AU - Marcello Capriata
AU - Livia Donzelli
AU - Gianna Maria D'Elia
AU - Salvatore Giacomo Morano
AU - Ilaria Del Giudice
AU - Maurizio Martelli
AU - Cristina Santoro
AU - Antonio Chistolini
PY - 2026
DA - 2026/08/03
JO - European Journal of Haematology
DO - 10.1111/ejh.70262
UR - https://doi.org/10.1111/ejh.70262
AB - Thrombotic events, particularly venous thromboembolism (VTE), are a significant source of morbidity and mortality among patients with hematologic malignancies. These patients face unique challenges due to treatment‐related complications such as thrombocytopenia, coagulopathy, and heightened bleeding risk. Traditionally managed with low molecular weight heparin (LMWH), the advent of direct oral anticoagulants (DOACs) has introduced new opportunities for both prophylaxis and treatment of cancer‐associated thrombosis (CAT). This narrative review explores the disease‐specific thrombotic risk across hematologic malignancies and critically evaluates the current evidence supporting the use of DOACs in this setting. While emerging data suggest DOACs are effective and safe for VTE treatment and secondary prophylaxis, although with a higher incidence of clinically relevant non‐major bleeding in some studies, their role in primary prophylaxis remains under investigation and is currently limited by insufficient disease‐specific data. Laboratory monitoring may be warranted in the presence of anti‐cancer treatment‐DOACs interactions or unexpected clinical events. The utility of DOACs is particularly constrained in thrombocytopenic patients, where bleeding risks are heightened and evidence remains limited. Overall, this review highlights the need for robust, prospective, disease‐specific trials to define optimal anticoagulation strategies in oncohematologic patients and refine clinical decision‐making in this complex and high‐risk population.
SN - 0902-4441
SN - 1600-0609
ER -