In cancer-associated thrombosis, which anticoagulation strategy is preferred?

• A. Subcutaneous low molecular weight heparin
• B. Warfarin therapy
• C. Direct oral anticoagulants
• D. Unfractionated heparin

Answer: (A)

In cancer-associated thrombosis, the priority is to reduce recurrent clots while avoiding interactions and burdens that chemotherapy adds. Subcutaneous low molecular weight heparin is preferred because it has shown superior prevention of recurrent VTE in cancer patients compared with warfarin, based on landmark trials. It also offers predictable effects with fewer drug interactions and doesn’t require routine laboratory monitoring. Unfractionated heparin needs IV administration and ongoing monitoring, making it less convenient for long-term outpatient use. Warfarin, while oral, is less reliable in cancer due to interactions with chemotherapy, variable nutrition, and unstable INR, leading to higher recurrence risk. Direct oral anticoagulants are used in many situations but were not the first-line choice in classic cancer-associated thrombosis management. Therefore, the best option is subcutaneous LMWH.