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Background: Cancer-associated venous thromboembolism (CAT) has detrimental impact on patients' clinical outcomes and quality of life. Data on CAT education, communication, and awareness among the general cancer population are scanty., Methods: We present the preliminary results of an ongoing patient-centered survey including 27 items covering major spheres of CAT. The survey, available in 14 languages, was promoted and disseminated online through social networks, email newsletters, websites, and media., Results: As of September 20, 2022, 749 participants from 27 countries completed the survey. Overall, 61.8% (n = 460) of responders were not aware of their risk of CAT. Among those who received information on CAT, 26.2% (n = 56) were informed only at the time of CAT diagnosis. Over two thirds (69.1%, n = 501) of participants received no education on signs and symptoms of venous thromboembolism (VTE); among those who were educated about the possible clinical manifestations, 58.9% (n = 119) were given instructions to seek consultation in case of VTE suspicion. Two hundred twenty-four respondents (30.9%) had a chance to discuss the potential use of primary thromboprophylaxis with health-care providers. Just over half (58.7%, n = 309) were unaware of the risks of bleeding associated with anticoagulation, despite being involved in anticoagulant-related discussions or exposed to anticoagulants. Most responders (85%, n = 612) valued receiving CAT education as highly relevant; however, 51.7% (n = 375) expressed concerns about insufficient time spent and clarity of education received., Conclusions: This ongoing survey involving cancer patients with diverse ethnic, cultural, and geographical backgrounds highlights important patient knowledge gaps. These findings warrant urgent interventions to improve education and awareness, and reduce CAT burden., (© 2022 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.)

Myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (MF) are stem cell clonal neoplasms characterized by expansion of late myeloid cells. Thrombosis risk is elevated in MPNs and contributes significantly to morbidity and mortality. Current consensus guidelines make no specific recommendations regarding anticoagulant choice for the treatment of venous thromboembolism (VTE) in MPNs, with most evidence supporting the use of vitamin K antagonists (VKAs) for secondary prophylaxis. However, direct oral anticoagulants (DOACs) are now increasingly being used, although with limited data on safety and efficacy in MPNs specifically. The widespread adoption of DOACs is based on new, high-quality evidence demonstrating safety and efficacy of DOAC treatment for cancer-associated VTE. However, these studies include few if any MPN patients, and MPNs have disease-specific considerations that may elevate thrombosis and bleeding risk. The purpose of this review is to discuss evidence behind current treatment recommendations for thrombosis in MPNs, with special attention to the use of DOACs.

International and national guidelines recommend low-molecular-weight heparin for the treatment of venous thromboembolism (VTE) in patients with cancer. The aim of the Caravaggio study is to assess whether oral apixaban is non-inferior to subcutaneous dalteparin for the treatment of acute proximal deep vein thrombosis and/or pulmonary embolism in patients with cancer. The study is an investigator-initiated, multi-national, prospective, randomized, open-label with blind end-point evaluation (PROBE), non-inferiority clinical trial (NCT03045406). Consecutive patients are randomized to receive oral apixaban or subcutaneous dalteparin for 6 months. Apixaban is given at a dose of 10 mg twice daily for the first 7 days and then 5 mg twice daily; dalteparin is given at a dose of 200 IU/kg for the first month and then 150 IU/kg once daily. The primary outcome of the study is objectively confirmed recurrent VTE as assessed by a central independent adjudication committee unaware of study treatment allocation. The primary safety outcome is major bleeding defined according to the guidelines of the International Society of Thrombosis and Haemostasis. Assuming a 6-month incidence of the primary outcome of 7% with dalteparin and an upper limit of the two-sided 95% confidence interval of the hazard ratio below the pre-specified margin of 2.00, 1,168 patients will be randomized considering an up to 20% loss in total patient-years ( β  = 80%; α one-sided = 0.025). The Caravaggio study has the potential, along with other recently performed or on-going studies, to make less cumbersome the management of VTE in patients with cancer by replacing parenteral with oral anticoagulation., Competing Interests: Giancarlo Agnelli reports personal fees from Bayer Healthcare, Bristol-Myers-Squibb, Daiichi Sankyo and Pfizer. Rupert Bauersachs has received funding from Bayer, BMS, Boehringer Ingelheim, Daiichi-Sankyo and Pfizer for consulting work and speaker bureaus. Cecilia Becattini reports personal fee from Bayer HealthCare and Bristol-Myers-Squibb. Benjamin Brenner has received personal fees from Bayer Healthcare, Pfizer, Leo Pharma, Sanofi and Rovi Laboratories. Mauro Campanini reports no potential conflict of interest. Alexander Cohen has received consulting fees from AbbVie, ACI Clinical, Aspen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Boston Scientific, CSL Behring, Daiichi-Sankyo, GlaxoSmithKline, GLG, Guidepoint Global, Johnson and Johnson, Leo Pharma, Medscape, McKinsey, Navigant, ONO, Pfizer, Portola, Sanofi, Takeda, Temasek Capital and TRN; he reports advisory board membership with Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Johnson and Johnson, ONO, Pfizer, Portola and Sanofi; and payments for lectures including speakers bureau services, payments for preparation of reports and payment for development of educational presentations from Aspen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi, GlaxoSmithKline, Johnson and Johnson, Medscape, Pfizer and Portola. He is an advisor to the U.K. Government Health Select Committee, the all-party working group on thrombosis, the Department of Health and the NHS, on the prevention of VTE. He is also an advisor to Lifeblood: The Thrombosis Charity and is the founder of the European educational charity the Coalition to Prevent Venous Thromboembolism. Jean Connors reports personal fees from Boehringer Ingelheim, Bristol Meyer Squibb/Pfizer, Unum Therapeutics and Proteostasis. Gualberto Gussoni reports no potential conflict of interest. Andrea Fontanella reports no potential conflict of interest. Menno Huisman has received research grants from ZonMW, Boehringer Ingelheim, Pfizer-Bristol-Myers-Squibb and Bayer Health; and has provided lectures and consultations for Bayer Health Care, Pfizer- Bristol-Myers Squibb and Boehringer Ingelheim. Guy Meyer has served as uncompensated advisor for Bayer Healthcare, Leo Pharma, BMS-Pfizer, Daiichi Sankyo, as a speaker (uncompensated) for Leo Pharma, Sanofi Aventis, Boehringer-Ingelheim and Bayer and received research grants or support through its institution from Leo Pharma, Boehringer-Ingelheim, Sanofi Aventis and Bayer Healthcare. He received travel and accommodation support from Leo Pharma, Boehringer-Ingelheim, Bayer Healthcare, BMS-Pizer and Daiichi Sankyo. Andrès Muñoz reports personal fees from Sanofi, Leo Pharma, Bayer Healthcare and Rovi. Joachim Jabreu Sousa reports no potential conflict of interest. Adam Torbicki reports honoraria for consultancy and/or lectures from Actelion, AOP, Arena, Bayer, Pfizer, MSD and United Therapeutics. Melina Verso reports no potential conflict of interest. Giorgio Vescovo reports no potential conflict of interest., (Georg Thieme Verlag KG Stuttgart · New York.)

Dabigatran etexilate is the first commercially available oral direct thrombin inhibitor. A single trial has studied patients at risk for stroke associated with nonvalvular atrial fibrillation; in this trial, dabigatran 150 mg twice a day met the criteria for superiority over warfarin in preventing stroke and systemic embolism while reducing the rate of hemorrhagic stroke with a similar risk of major bleeding. For the treatment of venous thromboembolism, dabigatran 150 mg twice a day had comparable efficacy and safety versus warfarin. In contrast, dabigatran was less effective than enoxaparin 30 mg twice a day in venous thromboembolism prevention in orthopedic surgery. Advantages of dabigatran over warfarin include its lack of need for routine laboratory monitoring, a fixed-dose regimen, and potentially fewer clinically important drug interactions. Concerns include higher incidences of dyspepsia and gastrointestinal bleeding, twice-daily dosing, and lack of effective antidote. Additional drawbacks include higher drug cost versus warfarin, accumulation in case of renal impairment, higher discontinuation rates due to adverse events, and limited long-term safety and trial data. From a payer perspective, overall costs will be higher with dabigatran compared with warfarin, but dabigatran does meet the threshold to be considered a cost-effective therapy. In addition, the lack of need for regular laboratory monitoring is a quality of life advantage for patients on dabigatran. These observations suggest that dabigatran is a valuable addition to the therapeutic armamentarium for stroke prevention in selected patients with atrial fibrillation although caution should be exercised given the limited data on this agent and higher cost.