Key result
Real-world data suggest DOACs have a lower risk of recurrent venous thromboembolism compared with LMWHs and warfarin, with treatment adherence ranging from 100% to 67.3% at 6 months.
Why the study?
Patients with cancer are at high risk for thrombotic events, and the authors sought to evaluate real world data regarding treatment patterns of cancer-associated thrombosis.
Do DOACs reduce recurrent venous thromboembolism compared to LMWHs and warfarin in patients with cancer-associated thrombosis in real-world settings?
Do DOACs reduce recurrent venous thromboembolism compared to LMWHs and warfarin in patients with cancer-associated thrombosis in real-world settings?
Real-world data suggest DOACs may reduce recurrent VTE compared to LMWHs and warfarin in cancer-associated thrombosis, but findings are limited by observational biases.
LMWHs predominate for initial CAT in RWD; leaves open optimal DOAC sequencing across cancer subtypes.
PURPOSE OF REVIEW: Patients with cancer are at high risk for thrombotic events, mainly deep vein thrombosis and pulmonary embolism. Low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are among the current treatment options for cancer-associated thrombosis (CAT). We assessed real world data (RWD) regarding treatment patterns of CAT from 1 September 2018 to 31 January 2020. RECENT FINDINGS: RWD showed that LMWHs were the most common initial anticoagulation treatment for CAT. Based on these data DOACs had a lower risk of recurrent venous thromboembolism compared with LMWHs and warfarin. However, the selection bias and the small number of patients in these studies might explain this difference and these limitations should be taken into consideration. Moreover, there was no statistical difference regarding adverse events during anticoagulant treatment between LMWHs and DOACs with the limitations of RWD. As far as the duration of the treatment is concerned, the adherence ranged from 100% to 67.3% at 6 months. SUMMARY: The current review of RWD illustrates that LMWHs and DOACs are used for the treatment of CAT. LMWHs are most commonly used for the initial management of CAT. Data regarding recurrence of CAT, adverse events, compliance and duration of anticoagulant treatment should be analyzed with caution as RWD are observational studies with many limitations. Further research is needed to elucidate the best algorithm for the management of CAT.
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Tsoukalas et al. (2020) conducted a review in Cancer-associated thrombosis. Direct oral anticoagulants (DOACs) vs. Low-molecular-weight heparins (LMWHs) and warfarin was evaluated on Recurrent venous thromboembolism. Real-world data suggest DOACs have a lower risk of recurrent venous thromboembolism compared with LMWHs and warfarin, with treatment adherence ranging from 100% to 67.3% at 6 months.
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