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Cancer-Associated VTE — RACP Adult Medicine MCQ

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ModerateMedical OncologyCancer-Associated VTERACP Adult Medicine

A 70-year-old woman with breast cancer receiving adjuvant chemotherapy develops symptomatic DVT of the left femoral vein. She has normal renal function. What is the preferred anticoagulant?

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Correct answer: D — Rivaroxaban (or apixaban)

LMWH was historically the standard for cancer-associated VTE. However, the SELECT-D and Caravaggio trials demonstrated that DOACs (edoxaban, rivaroxaban, apixaban) are non-inferior to LMWH with comparable safety. Current ISTH 2023 and Cancer Council Australia guidelines now recommend DOACs (apixaban or rivaroxaban) as preferred first-line for cancer-associated VTE, EXCEPT in GI/genitourinary cancers with high mucosal bleeding risk, where LMWH is preferred.

Reference: Cancer Council Australia – 2022 – Cancer-Associated VTE Guidelines; ISTH – 2023 – Cancer VTE Guidance