This review article describes insights into the prevention and treatment of cancer-associated venous thromboembolism (VTE) with direct factor Xa inhibitors (FXaI) and refers in particular to the CALLISTO study program with rivaroxaban. CALLISTO includes randomized clinical trials on different topics as well as real-world evidence.Prevention and treatment of cancer-associated VTE have so far relied on low molecular weight heparins (LMWH). Meanwhile, randomized controlled trials have found comparable to superior efficacy of FXaI vs. LMWH, and the findings are now being incorporated into recommendations and guidelines. A possibly increased risk of bleeding, especially in patients with unresected gastrointestinal or urogenital tumors, should be considered. This was first observed during therapy with FXaI but can also affect LMWH. The selection of suitable patients and the optimization of treatment pathways are therefore of great importance.
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