Anticoagulation challenges in cancer patients: prevention, detection, and treatment strategies.

Cancer-associated thrombosis is one of the most common and serious complications in oncology patients, contributing significantly to morbidity and mortality. This prothrombotic state is driven by cancer-related factors, systemic inflammation, and treatment-induced endothelial injury. Anticoagulation management in these patients is challenging, as both thrombotic and bleeding risks must be carefully balanced, particularly in those with cardiovascular comorbidities. This review examines the complexities of anticoagulation in cancer-associated thrombosis through three clinical cases. Case 1 focuses on thrombosis associated with central venous catheters, exploring prevention strategies and therapeutic approaches. Case 2 discusses the management of venous thromboembolism in metastatic prostate cancer with concurrent cardiovascular disease, emphasizing the challenges of overlapping arterial and venous risks. Case 3 highlights the interplay between immune checkpoint inhibitors and postoperative atrial fibrillation in a patient with non-small cell lung cancer, exploring immune-mediated mechanisms and their implications for anticoagulation. The review also discusses advances in risk stratification tools, detection methods, and emerging therapies such as FXI inhibitors. Effective management of anticoagulation in cancer patients requires personalized strategies that consider cancer-specific risks, treatment-related factors, and comorbidities. Advances in biomarkers, predictive models, and innovative therapies hold promise for improving outcomes in this high-risk population.