Thrombosis Across Female‐Specific Malignancies: From Chemotherapy‐Driven Risk to Prophylaxis and Drug Interactions
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2026
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| author | Maryam Aghakouchakzadeh Hessam Kakavand Anne J. Goldberg Melissa Accordino Meghna Trivedi Jayant K. Raikhelkar Azita H. Talasaz |
| author_facet | Maryam Aghakouchakzadeh Hessam Kakavand Anne J. Goldberg Melissa Accordino Meghna Trivedi Jayant K. Raikhelkar Azita H. Talasaz Maryam Aghakouchakzadeh Hessam Kakavand Anne J. Goldberg Melissa Accordino Meghna Trivedi Jayant K. Raikhelkar Azita H. Talasaz |
| collection | Wiley Open Access |
| contents | Thrombosis Across Female‐Specific Malignancies: From Chemotherapy‐Driven Risk to Prophylaxis and Drug Interactions Maryam Aghakouchakzadeh Hessam Kakavand Anne J. Goldberg Melissa Accordino Meghna Trivedi Jayant K. Raikhelkar Azita H. Talasaz Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy ABSTRACT Cancer‐associated thrombosis (CAT) remains a leading cause of morbidity and mortality among patients with cancer. Female‐specific malignancies such as breast, ovarian, endometrial, and cervical cancers exhibit distinct thrombotic profiles driven by hormonal, anatomical, and treatment‐related factors. This review summarizes current evidence on CAT in these malignancies, emphasizing chemotherapy‐ and hormone‐related risk, thromboprophylactic strategies, and pharmacologic considerations in anticoagulant selection. Ovarian cancer carries the highest incidence of venous thromboembolism (VTE), ranging from 5% to 14%, largely due to advanced disease, ascites, and platinum‐based chemotherapy. Breast cancer accounts for approximately 15% of all CAT cases, with increased risk observed among patients treated with selective estrogen receptor modulators or cyclin‐dependent kinase 4/6 inhibitors. Endometrial cancer presents a moderate to high risk for CAT, especially in obese patients and those receiving hormonal therapy or radiation. Prophylaxis with low‐molecular‐weight heparins (LMWHs) or direct oral anticoagulants (DOACs) effectively reduces VTE incidence in high‐risk patients. In the API‐CAT trial, reduced‐dose apixaban (2.5 mg twice daily) was non‐inferior to full‐dose therapy for extended anticoagulation after 6 months of treatment (2.1% vs. 2.8%; adjusted subhazard ratio, 0.76; 95% Confidence Interval (CI), 0.58–0.97; p = 0.001). Drug–drug interactions with anticoagulants and agents such as doxorubicin, ribociclib, and tamoxifen warrant individualized anticoagulant selection and close monitoring. A patient‐centered pharmacotherapeutic approach, supported by multidisciplinary collaboration, is essential to optimize thrombosis prevention and minimize bleeding risk in women with cancer. 10.1002/phar.70149 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1002/phar.70149 |
| format | Artículo Open Access |
| id | wiley_oa_10_1002_phar_70149 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2026 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Thrombosis Across Female‐Specific Malignancies: From Chemotherapy‐Driven Risk to Prophylaxis and Drug Interactions Maryam Aghakouchakzadeh Hessam Kakavand Anne J. Goldberg Melissa Accordino Meghna Trivedi Jayant K. Raikhelkar Azita H. Talasaz Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy Thrombosis Across Female‐Specific Malignancies: From Chemotherapy‐Driven Risk to Prophylaxis and Drug Interactions Maryam Aghakouchakzadeh Hessam Kakavand Anne J. Goldberg Melissa Accordino Meghna Trivedi Jayant K. Raikhelkar Azita H. Talasaz Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy ABSTRACT Cancer‐associated thrombosis (CAT) remains a leading cause of morbidity and mortality among patients with cancer. Female‐specific malignancies such as breast, ovarian, endometrial, and cervical cancers exhibit distinct thrombotic profiles driven by hormonal, anatomical, and treatment‐related factors. This review summarizes current evidence on CAT in these malignancies, emphasizing chemotherapy‐ and hormone‐related risk, thromboprophylactic strategies, and pharmacologic considerations in anticoagulant selection. Ovarian cancer carries the highest incidence of venous thromboembolism (VTE), ranging from 5% to 14%, largely due to advanced disease, ascites, and platinum‐based chemotherapy. Breast cancer accounts for approximately 15% of all CAT cases, with increased risk observed among patients treated with selective estrogen receptor modulators or cyclin‐dependent kinase 4/6 inhibitors. Endometrial cancer presents a moderate to high risk for CAT, especially in obese patients and those receiving hormonal therapy or radiation. Prophylaxis with low‐molecular‐weight heparins (LMWHs) or direct oral anticoagulants (DOACs) effectively reduces VTE incidence in high‐risk patients. In the API‐CAT trial, reduced‐dose apixaban (2.5 mg twice daily) was non‐inferior to full‐dose therapy for extended anticoagulation after 6 months of treatment (2.1% vs. 2.8%; adjusted subhazard ratio, 0.76; 95% Confidence Interval (CI), 0.58–0.97; p = 0.001). Drug–drug interactions with anticoagulants and agents such as doxorubicin, ribociclib, and tamoxifen warrant individualized anticoagulant selection and close monitoring. A patient‐centered pharmacotherapeutic approach, supported by multidisciplinary collaboration, is essential to optimize thrombosis prevention and minimize bleeding risk in women with cancer. 10.1002/phar.70149 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Thrombosis Across Female‐Specific Malignancies: From Chemotherapy‐Driven Risk to Prophylaxis and Drug Interactions |
| topic | Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy |
| url | https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.70149 |