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

Wei Kang, Caige Huang, Vincent K. C. Yan, Yue Wei, Jessica J. P. Shami, Silvia T. H. Li, Yu Yang, Xuxiao Ye, Junhan Tang, Shing Fung Lee, Victor H. F. Lee, Stephen L. Chan, Aya El Helali, Ka On Lam, Roger K. C. Ngan, Ian C. K. Wong and Esther W. Chan ()
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Wei Kang: The University of Hong Kong
Caige Huang: The University of Hong Kong
Vincent K. C. Yan: The University of Hong Kong
Yue Wei: The University of Hong Kong
Jessica J. P. Shami: The University of Hong Kong
Silvia T. H. Li: The University of Hong Kong
Yu Yang: The University of Hong Kong
Xuxiao Ye: The University of Hong Kong
Junhan Tang: The University of Hong Kong
Shing Fung Lee: National University Hospital
Victor H. F. Lee: The University of Hong Kong
Stephen L. Chan: The Chinese University of Hong Kong
Aya El Helali: The University of Hong Kong
Ka On Lam: The University of Hong Kong
Roger K. C. Ngan: The University of Hong Kong
Ian C. K. Wong: The University of Hong Kong
Esther W. Chan: The University of Hong Kong

Nature Communications, 2024, vol. 15, issue 1, 1-11

Abstract: 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.

Date: 2024
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DOI: 10.1038/s41467-024-50037-1

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