Direct oral anticoagulants for cancer-associated venous thromboembolism in Japan

Cancer-associated venous thromboembolism is a severe and potentially fatal event. Over the past few years, results from several randomized control trials have been published, and direct oral anticoagulants are becoming new standard care for this disease in addition to low molecular weight heparins. Although Japanese patients have seldom participated in these trials, direct oral anticoagulants are widely used in current practice, especially because low molecular weight heparins have not been approved for acute venous thromboembolism in Japan. Since the “East Asian paradox” meant a unique risk-benefit compromise, less anti-ischemic benefits and more risk of bleeding during antithrombotic therapies compared with Caucasian patients, direct extrapolation of Caucasian data to Japanese could be inappropriate. Polymorphisms among anticoagulant factors, cytochrome P450 metabolisms, and ATP-binding cassette transporters may be important biological factors to explain the ethnic disparity. This special issue will focus on the current evidence and future directions of direct oral anticoagulants for cancer-associated venous thromboembolism in Japanese patients.

22/12/2024