Comparative characteristics of anticoagulants used in cancer-associated thrombosis

Introduction Cancer-associated thrombosis (CAT) significantly worsens the prognosis of patients increasing both the risk of bleeding and thrombotic recurrence events despite optimal anticoagulant therapy. Purpose The aim of the study is to compare effectiveness and safety of different anticoagulants in CAT. Methods We included CAT patients retrospectively and prospectively. Anticoagulant therapy was initiated according to individualized patients’ characteristics. Four groups were formed based on the prescribed anticoagulant: direct oral anticoagulants (DOACs; 53.4%), vitamin K antagonists (VKAs; 3.9%), parenteral anticoagulants (13.6%), and without any anticoagulant (29.1%). We compared mortality, bleeding, and recurrent events between these groups on the sixth month of the follow-up. Results We included 103 patients (mean age 65.3; 49.5% female; 66% with metastatic disease), 59.2% with hypertension, 12.6% with atrial fibrillation, 12.6% with coronary artery disease, and 10.7% with heart failure. 82.5% were diagnosed with venous thromboembolism, 13.6% with arterial thrombosis, and 3.87% with both arterial and venous thrombosis. The most common type of thrombosis was pulmonary embolism (46.6%). 22.33% of patients had bleeding events: 12.6% major, 5.8% clinically relevant non-major (CRNM), and 3.9% minor bleeding. The tumors most associated with bleeding were gastrointestinal and gynecological. The bleeding rate was not significantly different between the groups. There were 14.6% recurrent events. The only result with borderline statistical significance regarding recurrence was the comparison between patients treated with DOACs and those treated with parenteral anticoagulants, in favor of DOACs. The tumors most associated with recurrence were lung, gastric, and bladder cancer. The mortality rate was high: 52.4% of patients died during the follow-up, with no statistical significance among the groups. Conclusion There is still no optimal anticoagulant regimen suitable for all cases of CAT with a predictable effect, limiting both recurrence and bleeding events. There is no statistical significance between different anticoagulation regimen groups regarding mortality, bleeding, and recurrence.