Direct-acting oral anticoagulants are associated with the lowest recurrence of venous thromboembolism and lowest mortality.

In patients with cancer who develop venous thromboembolism (VTE), US guidelines now recommend direct-acting oral anticoagulants (DOACs) over low-molecular-weight heparin (LMWH) due to better efficacy and safety. In a real-world retrospective cohort of 5100 insured patients with various types of cancers (60% with metastatic disease), half received DOACs, one-quarter received LMWH and one-quarter received warfarin. Median treatment duration was approximately three months.

In propensity-score-weighted analysis, VTE recurrence was significantly less likely in patients who received DOACs than in those who received warfarin or LMWH (20 vs 30 and 40 VTEs per 100 person-years, respectively). Mortality was significantly lower in DOAC recipients than in LMWH recipients (11 vs 21 per 100 person-years), as were hospitalisations for bleeding (10 vs 27 per 100 person-years).

Comment: Although treatment duration in this patient population was short, likely due to disease complexity and patient prognosis, DOAC therapy still showed dramatic efficacy and safety advantages over LMWH for VTE in patients with various types of cancer. DOACs are supported by randomised trials, guidelines and now real-world data for this indication.

Daniel D. Dressler, MD, MSc, MHM, FACP, Professor of Medicine, Emory University School of Medicine, Atlanta, USA.

Riaz IB, et al. Comparative effectiveness of anticoagulants in patients with cancer- associated thrombosis. JAMA Netw Open 2023; 6: e2325283.

This summary is taken from the following Journal Watch titles: General Medicine, Oncology and Hematology, Ambulatory Medicine, Hospital Medicine.