Effectiveness and safety of continuous low-molecular-weight heparin versus switching to direct oral anticoagulants in cancer-associated venous thrombosis

Nat Commun. 2024 Jul 5;15(1):5657. doi: 10.1038/s41467-024-50037-1.

Abstract

Given the existing uncertainty regarding the effectiveness and safety of switching from low-molecular-weight heparin (LMWH) to direct oral anticoagulants (DOACs) in patients with cancer-associated venous thrombosis (CAT), we conducted a comprehensive population-based cohort study utilizing electronic health database in Hong Kong. A total of 4356 patients with CAT between 2010 and 2022 were included, with 1700 (39.0%) patients switching to DOAC treatment. Compared to continuous LMWH treatment, switching to DOACs was associated with a significantly lower risk of hospitalization due to venous thromboembolism (HR: 0.49 [95% CI = 0.35-0.68]) and all-cause mortality (HR: 0.67 [95% CI = 0.61-0.74]), with no significant difference in major bleeding (HR: 1.04 [95% CI = 0.83-1.31]) within six months. These findings provide reassurance regarding the effectiveness and safety of switching from LMWH to DOACs among patients with CAT, including vulnerable patient groups.

MeSH terms

  • Administration, Oral
  • Aged
  • Aged, 80 and over
  • Anticoagulants* / administration & dosage
  • Anticoagulants* / adverse effects
  • Anticoagulants* / therapeutic use
  • Cohort Studies
  • Drug Substitution
  • Female
  • Hemorrhage* / chemically induced
  • Heparin, Low-Molecular-Weight* / administration & dosage
  • Heparin, Low-Molecular-Weight* / adverse effects
  • Heparin, Low-Molecular-Weight* / therapeutic use
  • Hong Kong / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Neoplasms* / complications
  • Neoplasms* / drug therapy
  • Treatment Outcome
  • Venous Thromboembolism / drug therapy
  • Venous Thromboembolism / etiology
  • Venous Thrombosis* / drug therapy

Substances

  • Heparin, Low-Molecular-Weight
  • Anticoagulants