ReviewJournal of thrombosis and thrombolysis2026
Coagulation disorders and thromboprophylaxis in pancreatic cancer: a review of current evidence and clinical challenges.
Review in Journal of thrombosis and thrombolysis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
7 authors.
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Abstract
Pancreatic cancer is one of the most thrombogenic malignancies. Venous thromboembolism (VTE) is a frequent and very severe complication. The risk of thrombosis and postoperative hemorrhage, especially post-pancreatectomy, makes thromboprophylaxis difficult to implement in clinical practice depending on what component dominates. A review was conducted using PubMed, Scopus, Web of Science, Elsevier, and Google Scholar databases. Studies published in English focusing on VTE pathophysiology, prevention, and treatment in pancreatic cancer were included. The evidence was summarized descriptively. Two randomized trials (FRAGEM and CONKO-004) have shown that intensified, weight-adjusted low-molecular-weight heparin (LMWH) significantly decreases the incidence of VTE in advanced pancreatic cancer (PC) without significantly increasing major bleeding or enhancing survival rates. Direct oral anticoagulants (DOACs) such as rivaroxaban and apixaban present potential as oral alternatives; however, they are associated with a greater risk of gastrointestinal bleeding. Following pancreatectomy, VTE occurs in 20-25% of patients-frequently after discharge-highlighting the necessity for extended prophylaxis lasting at least 28 days. Minimally invasive surgical techniques are linked to a marginally elevated risk of VTE when compared to open surgery. Nevertheless, the available data concerning dosing, timing, and the resumption of anticoagulation after post-pancreatectomy hemorrhage (PPH) is still inadequate. Current evidence supports the use of LMWH-based anticoagulation strategies for VTE prevention in pancreatic cancer; however, direct evidence for standard prophylactic dosing is lacking, as available randomized trials evaluated intensified regimens. DOACs may be used selectively, considering bleeding risk. The lack of pancreatic-cancer-specific dosing protocols and perioperative guidelines highlights the need for dedicated trials defining optimal anticoagulation strategies and safe timing of therapy after PPH.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.