Key result
Low body weight is not linked to higher major bleeding risk in cancer-associated VTE.
Why the study?
Data are limited regarding the impact of low body weight on clinical outcomes in patients with cancer-associated VTE in the DOAC era.
Does low body weight (≤60 kg) increase the risk of major bleeding, recurrent VTE, or all-cause death compared to non-low body weight (>60 kg) in patients with cancer-associated VTE?
Cohort (n=1,484)
Yes
Does low body weight (≤60 kg) increase the risk of major bleeding, recurrent VTE, or all-cause death compared to non-low body weight (>60 kg) in patients with cancer-associated VTE?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In this issue of the Journal, Kobayashi and colleagues investigate the clinical significance of low body weight (BW) in 1,484 patients with active cancer and acute symptomatic venous thromboembolism (VTE) enrolled in the COMMAND VTE Registry-2. The investigators should be commended for addressing a clinically relevant but insufficiently explored question in a large, multicenter, real-world cohort from the contemporary direct oral anticoagulant era, while appropriately accounting for death as a competing risk for nonfatal outcomes.”
“By demonstrating that death, rather than recurrent VTE, was the outcome most clearly associated with low BW, this study broadens the clinical meaning of BW in cancer-associated VTE. Although vigilance for bleeding remains warranted, these findings suggest that low BW may serve as a readily available marker of broader cancer-related vulnerability, extending beyond its role in anticoagulation management.”
In patients with cancer-associated VTE, low body weight (≤60 kg) is an independent predictor of all-cause mortality but not major bleeding or recurrent VTE, likely reflecting underlying cancer-related vulnerability.
BACKGROUND: Low body weight (BW) is reportedly associated with an increased risk of bleeding and mortality in venous thromboembolism (VTE). However, there are limited data on the impact of low BW on clinical outcomes among patients with cancer-associated VTE in the direct oral anticoagulants (DOACs) era. METHODS AND RESULTS: We analyzed 1,484 patients with symptomatic VTE and active cancer from the COMMAND VTE Registry-2, and divided the cohort into low (≤60 kg) and non-low (>60 kg) BW groups (n=969 and 515, respectively). The cumulative 3-year incidence of major bleeding was significantly higher in the low than non-low BW group (13.1% vs. 10.2%; Gray's P=0.04). However, after adjustment, the risk of major bleeding in the low BW was no longer significantly different to that in the non-low BW group (hazard ratio [HR] 1.36; 95% confidence interval [CI] 0.96-1.92). The cumulative 3-year incidence of recurrent VTE did not differ significantly between the low and non-low groups (5.2% vs. 5.4%, respectively; Gray's P=0.46; adjusted HR 0.71; 95% CI 0.42-1.18). The cumulative 3-year incidence of all-cause death was significantly higher in the low than non-low BW group (65.0% vs. 50.8%; log-rank P<0.001; adjusted HR 1.47; 95% CI 1.25-1.73). CONCLUSIONS: Low BW in cancer-associated VTE was not associated with major bleeding or recurrent VTE, but was associated with all-cause death, possibly reflecting cancer-related prognostic factors.
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Kobayashi et al. (2026) conducted a cohort in Cancer-associated venous thromboembolism (n=1,484). Low body weight (≤60 kg) vs. Non-low body weight (>60 kg) was evaluated on Major bleeding (HR 1.36, 95% CI 0.96-1.92, p=0.08). Low body weight (≤60 kg) in patients with cancer-associated venous thromboembolism was not significantly associated with an increased risk of major bleeding compared to non-low body weight (adjusted HR 1.36).
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