{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T08:36:45Z","timestamp":1773995805451,"version":"3.50.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Patients with advanced, unresectable colorectal cancer in need of anticoagulation for deep vein thrombosis (DVT) with active or high-risk gastrointestinal bleeding (GIB) have a critical dilemma. Withholding anticoagulation has a risk of fatal thrombosis, while giving anticoagulation makes life-threatening bleeding worse. A retrievable inferior vena cava (IVC) filter may be a temporary stopgap while an active GIB is occurring. Once hemostasis has occurred, therapeutic anticoagulation should begin. Low molecular weight heparin (LMWH) is preferred over direct oral anticoagulants (DOAs) because of a lower risk of mucosal bleeding, and if necessary, apixaban is suggested. Dosing must be adjusted for thrombocytopenia. Management requires meticulous and individualized risk assessment. Future priorities include improved risk-prediction tools and targeted therapies to mitigate this precarious \u201ctherapeutic tightrope.\u201d<\/jats:p>","DOI":"10.3389\/fonc.2026.1758399","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T05:23:13Z","timestamp":1773984193000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk management in the dual crisis of unresectable colorectal cancer and deep vein thrombosis: navigating between hemorrhage and antithrombosis"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiaoqing","family":"Wu","sequence":"first","affiliation":[{"name":"Oncology Department, Wangjing Hospital of China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongxuan","family":"Tong","sequence":"additional","affiliation":[{"name":"Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"Oncology Department, Wangjing Hospital of China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"17025","DOI":"10.20452\/pamw.17025","article-title":"Extended anticoagulation in patients with cancer-associated venous thromboembolism","volume":"135","author":"Ghorbanzadeh","year":"2025","journal-title":"Pol Arch Intern Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2008.02987.x","article-title":"Tissue factor-bearing microparticles derived from tumor cells: impact on coagulation activation","volume":"6","author":"Davila","year":"2008","journal-title":"J Thromb Haemost"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-05-2042","article-title":"Oncogenic events regulate tissue factor expression in colorectal cancer cells: implications for tumor progression and angiogenesis","volume":"105","author":"Yu","year":"2005","journal-title":"Blood"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1038\/s41598-018-19889-8","article-title":"Tissue Factor-bearing MPs and the risk of venous thrombosis in cancer patients: A meta-analysis","volume":"8","author":"Cui","year":"2018","journal-title":"Sci Rep"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2011.10.025","article-title":"Anticancer treatment and thrombosis","volume":"129","author":"Falanga","year":"2012","journal-title":"Thromb Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.3390\/cancers16132356","article-title":"Haemostatic gene expression in cancer-related immunothrombosis: contribution for venous thromboembolism and ovarian tumour behaviour","volume":"16","author":"Tavares","year":"2024","journal-title":"Cancers (Basel)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.00294","article-title":"Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update","volume":"41","author":"Key","year":"2023","journal-title":"J Clin Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14564","article-title":"The use of direct oral anticoagulants for primary thromboprophylaxis in ambulatory cancer patients: Guidance from the SSC of the ISTH","volume":"17","author":"Wang","year":"2019","journal-title":"J Thromb Haemost"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12683","article-title":"Prevention of venous thromboembolism in hospitalized medical cancer patients: guidance from the SSC of the ISTH","volume":"12","author":"Di Nisio","year":"2014","journal-title":"J Thromb Haemost"},{"key":"B10","doi-asserted-by":"publisher","first-page":"483","DOI":"10.6004\/jnccn.2024.0046","article-title":"Cancer-associated venous thromboembolic disease, version 2.2024, NCCN clinical practice guidelines in oncology","volume":"22","author":"Streiff","year":"2024","journal-title":"J Natl Compr Canc Netw"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2301","article-title":"Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines","volume":"141","author":"Kearon","year":"2012","journal-title":"Chest"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa025313","article-title":"Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer","volume":"349","author":"Lee","year":"2003","journal-title":"N Engl J Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1002\/rth2.12002","article-title":"Current practice patterns and patient persistence with anticoagulant treatments for cancer-associated thrombosis","volume":"1","author":"Khorana","year":"2017","journal-title":"Res Pract Thromb Haemost"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.16342","article-title":"Thrombocytopenia in chronic liver disease: challenges and treatment strategies","volume":"13","author":"Desai","year":"2021","journal-title":"Cureus"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.7326\/M21-1474","article-title":"Rivaroxaban is associated with higher rates of gastrointestinal bleeding than other direct oral anticoagulants: A nationwide propensity score-weighted study","volume":"174","author":"Ingason","year":"2021","journal-title":"Ann Intern Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"100018","DOI":"10.1124\/jpet.124.002203","article-title":"Mechanisms and management of thrombosis in cancer: Focus on gastrointestinal Malignancies","volume":"392","author":"Monegatti","year":"2025","journal-title":"J Pharmacol Exp Ther"},{"key":"B17","doi-asserted-by":"publisher","first-page":"10760296221082988","DOI":"10.1177\/10760296221082988","article-title":"Direct oral anticoagulants for the treatment of cancer-associated venous thromboembolism: A latin american perspective","volume":"28","author":"Athanazio","year":"2022","journal-title":"Clin Appl Thromb Hemost"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1648003","article-title":"Risk factors for recurrence and bleeding in colorectal cancer patients with cancer-associated venous thrombembolism","volume":"15","author":"Liang","year":"2025","journal-title":"Front Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1711948","article-title":"Edoxaban for the treatment of cancer-associated venous thromboembolism","volume":"378","author":"Raskob","year":"2018","journal-title":"N Engl J Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2023.2934","article-title":"Systemic anticancer therapy and thromboembolic outcomes in hospitalized patients with cancer and COVID-19","volume":"9","author":"Gulati","year":"2023","journal-title":"JAMA Oncol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"100116","DOI":"10.1016\/j.bvth.2025.100116","article-title":"Risk factors for anticoagulant-related bleeding in cancer: traditional and cancer-specific factors","volume":"3","author":"Loncharich","year":"2026","journal-title":"Blood Vessel Thromb Hemost"},{"key":"B22","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1053\/j.gastro.2019.04.041","article-title":"Pantoprazole to prevent gastroduodenal events in patients receiving rivaroxaban and\/or aspirin in a randomized, double-blind, placebo-controlled trial","volume":"157","author":"Moayyedi","year":"2019","journal-title":"Gastroenterology"},{"key":"B23","doi-asserted-by":"publisher","first-page":"391","DOI":"10.4253\/wjge.v13.i9.391","article-title":"Gastrointestinal hemorrhage in the setting of gastrointestinal cancer: Anatomical prevalence, predictors, and interventions","volume":"13","author":"Minhem","year":"2021","journal-title":"World J Gastrointest Endosc"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1720975","article-title":"Bleeding with apixaban and dalteparin in patients with cancer-associated venous thromboembolism: results from the caravaggio study","volume":"121","author":"Ageno","year":"2021","journal-title":"Thromb Haemost"},{"key":"B25","doi-asserted-by":"publisher","first-page":"S8","DOI":"10.1016\/j.thromres.2021.12.025","article-title":"Contemporary breast cancer treatment-associated thrombosis","volume":"213","author":"Kirwan","year":"2022","journal-title":"Thromb Res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.cytogfr.2018.01.007","article-title":"The role of inflammatory cytokines and tumor associated macrophages (TAMs) in microenvironment of pancreatic cancer","volume":"39","author":"Farajzadeh Valilou","year":"2018","journal-title":"Cytokine Growth Fact Rev"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.74673","article-title":"Risk factors and outcomes of acute pulmonary embolism in african patients: A systematic review","volume":"16","author":"Okeke","year":"2024","journal-title":"Cureus"},{"key":"B28","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/j.chest.2024.03.003","article-title":"Antithrombotic therapy for VTE disease: compendium and review of CHEST guidelines 2012-2021","volume":"166","author":"Stevens","year":"2024","journal-title":"Chest"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2024015371","article-title":"Duration of primary\/secondary treatment to prevent recurrent venous thromboembolism: a systematic review and meta-analysis","volume":"9","author":"Li","year":"2025","journal-title":"Blood Adv"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1152312","article-title":"Pancreatic cancer and fibrosis: Targeting metabolic reprogramming and crosstalk of cancer-associated fibroblasts in the tumor microenvironment","volume":"14","author":"Li","year":"2023","journal-title":"Front Immunol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"101258","DOI":"10.1016\/j.lanwpc.2024.101258","article-title":"Epidemiology of pulmonary embolism in China, 2021: a nationwide hospital-based study","volume":"54","author":"Zhen","year":"2025","journal-title":"Lancet Reg Health West Pac"},{"key":"B32","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1024\/0301-1526\/a001156","article-title":"The Postthrombotic syndrome, where are we now","volume":"54","author":"Hupperetz","year":"2025","journal-title":"Vasa"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1016\/j.jvir.2011.08.024","article-title":"Systematic review of the use of retrievable inferior vena cava filters","volume":"22","author":"Angel","year":"2011","journal-title":"J Vasc Interv Radiol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318214914f","article-title":"Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association","volume":"123","author":"Jaff","year":"2011","journal-title":"Circulation"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.78.8034","article-title":"Comparison of an oral factor xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D)","volume":"36","author":"Young","year":"2018","journal-title":"J Clin Oncol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915103","article-title":"Apixaban for the treatment of venous thromboembolism associated with cancer","volume":"382","author":"Agnelli","year":"2020","journal-title":"N Engl J Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2025.03.005","article-title":"Perioperative management of oral anticoagulation in patients with venous thromboembolism","volume":"109","author":"Sherwood","year":"2025","journal-title":"Med Clin North Am"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.07.055","article-title":"Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report","volume":"160","author":"Stevens","year":"2021","journal-title":"Chest"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2015.11.026","article-title":"Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report","volume":"149","author":"Kearon","year":"2016","journal-title":"Chest"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2022.07.025","article-title":"Perioperative management of antithrombotic therapy: an american college of chest physicians clinical practice guideline","volume":"162","author":"Douketis","year":"2022","journal-title":"Chest"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000142859.77578.C9","article-title":"Single-arm study of bridging therapy with low-molecular-weight heparin for patients at risk of arterial embolism who require temporary interruption of warfarin","volume":"110","author":"Kovacs","year":"2004","journal-title":"Circulation"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.3390\/pharmaceutics16111449","article-title":"Evaluation of drug-drug interactions between clarithromycin and direct oral anticoagulants using physiologically based pharmacokinetic models","volume":"16","author":"Yang","year":"2024","journal-title":"Pharmaceutics"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2025.01.007","article-title":"Potential interactions between antimicrobials and direct oral anticoagulants: Population-based cohort and case-crossover study","volume":"22","author":"Wong","year":"2025","journal-title":"Heart Rhythm"},{"key":"B44","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s42492-025-00204-y","article-title":"Development and validation of a machine learning model for predicting venous thromboembolism complications following colorectal cancer surgery","volume":"8","author":"Sun","year":"2025","journal-title":"Vis Comput Ind BioMed Art"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1758399\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T05:23:15Z","timestamp":1773984195000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1758399\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":44,"alternative-id":["10.3389\/fonc.2026.1758399"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1758399","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]},"article-number":"1758399"}}