Efficacy and safety of direct oral anticoagulants versus warfarin in elderly patients with cancer-associated venous thromboembolism

Background Little is known about the effects of direct oral anticoagulants (DOACs) in cancer[1]related venous thromboembolism patients. Methods Data of patients with cancer-related venous thromboembolism (VTE) were retrieved from King Abdulaziz Medical City Database during 2016–2020. We excluded patients who were not using oral anticoagulants, used anticoagulants for <30 days, used 2 agents concomitantly or switched anticoagulants,were aged <65. The primary outcomes were recurrent VTE,major bleeding, and death from any cause. Results We identified 717 patients who received a diagnosis of cancer-related VTE. After the exclusion criteria were applied, 445 patients remained, 298 were used warfarin, and 147 were received NOACs. Both groups were followed up for 12±2 months. The mean age of the patients was 71 ± 8 in the DOACs group and 76 ±6 in the warfarin group (p > 0.05); 48.24% of patients in the DOAC group and 46.98% of patients in the warfaringroup were men (p > 0.05). The mean HAS-BLED score was 3.7 ± 3.8 in the NOAC group and 3.8 ± 3.9 in the warfaringroup (p > 0.05). Furthermore, among patients with cancer-related VTE, DOAC was associated with no difference in major bleeding or recurrence events (CRR = 0.91, 95% CI = 0.78–1.05; CRR = 0.63, 95% CI = 0.52–0.77, respectively), and significantly reduced death from any cause (aHR = 0.65, 95% CI = 0.52–0.80) compared with warfarin. Conclusions In elderly patients with cancer-related VTE, DOAC was associated with reduced death from any cause compared with warfarin, whereas no difference in major bleeding or recurrent VTE were observed between these treatment modalities.