Update for: Thrombin Inhibition Preoperatively (TIP) in Early Breast Cancer, the first clinical trial of DOACs as an anti-cancer agent

Introduction: Tumour expression of extrinsic clotting pathway markers are increased in oestrogen receptor (ER) negative, high Ki67, more aggressive breast cancer subtypes. In in vitro and in vivo studies, the extrinsic clotting pathway promotes cancer growth and metastasis. Cancer stem-like cells (CSCs) are a subpopulation of cancer cells that are resistant to chemotherapy, endocrine therapy and radiotherapy and play a role in recurrence. In vitro, Direct Oral Anticoagulants inhibit breast cancer stem cell activity.