Management of cancer-associated venous thromboembolism: Perspectives on optimizing current therapeutics with a focus on factor XI inhibition

Cancer-associated thrombosis (CAT) encompasses manifestations of deep venous thrombosis and/or pulmonary embolism occurring during the evolution of cancer. CAT represents one of the major cardiovascular complications associated with cancer and anti-cancer treatments, and the second leading cause of death after cancer progression. The rate of venous thromboembolism (VTE) recurrence is augmented in patients with cancer, together with the risk of bleeding, when compared with subjects without malignancy. Thus, decisions on optimal anticoagulation strategy should carefully balance both thrombotic and bleeding risk. While low-molecular weight heparins and direct oral anticoagulants now represent the standard-of-care in patients with cancer, newer pharmacologic compounds able to prevent VTE recurrence while minimizing the hemorrhagic risk are needed, and currently under investigation. In particular, factor XI inhibitors have emerged as potentially safe drugs in this highly vulnerable population, although results from dedicated clinical trials are waited to confirm this hypothesis. This review aims to summarize current management, controversies, and latest developments in pharmacotherapeutic approaches for patients with CAT.