Key result
Prolonged DOAC therapy shows no benefit over shorter treatment in cancer-associated isolated distal DVT.
Why the study?
The efficacy and bleeding complications of DOAC therapy for cancer-associated isolated distal deep vein thrombosis in routine clinical practice remain unclear, and prior studies on prolonged therapy are limited.
Cohort (n=200)
Yes
High bleeding rates warrant caution with DOACs for cancer-associated distal DVT; leaves open optimal duration pending prospective trials.
BACKGROUND: The efficacy and bleeding complications of direct oral anticoagulant (DOAC) therapy for isolated distal deep vein thrombosis (IDDVT) associated with cancer in routine clinical practice remain unclear. Moreover, prior studies on prolonged therapy for IDDVT are limited. METHODS: This retrospective study enrolled 1641 consecutive patients with acute venous thromboembolism (VTE) who had received oral anticoagulant therapy, including warfarin or DOAC, between April 2014 and September 2018 in our institutions. In these patients, 200 patients with cancer-associated IDDVT were evaluated. RESULTS: Mean follow-up period was 780 ± 593 days. Major bleeding and VTE recurrence were observed in 22 (11.0%) and 11 (5.5%) patients, respectively. In multivariate analysis, statistically significant factors correlated with major bleeding were advanced cancer stage, high performance status, stomach cancer, and gallbladder cancer; those correlated with all-cause death were advanced cancer stage, high performance status, liver dysfunction, pancreatic cancer, and major bleeding. Cumulative events of major bleeding and recurrence between patients with prolonged DOAC therapy (≥90 days) and those with nonprolonged therapy were not significantly different. CONCLUSIONS: Preventing major bleeding is important because it is a significant risk factor for all-cause death. Major bleeding and recurrent events were comparable between prolonged and nonprolonged therapy.
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Ogino et al. (2021) conducted a cohort in Cancer-associated isolated distal deep vein thrombosis (IDDVT) (n=200). Prolonged DOAC therapy (≥90 days) vs. Nonprolonged DOAC therapy (<90 days) was evaluated on Major bleeding and recurrent venous thromboembolism (VTE). Direct oral anticoagulant therapy in cancer-associated isolated distal DVT resulted in an 11.0% major bleeding rate and 5.5% VTE recurrence rate, with no significant difference between prolonged and nonprolonged therapy.
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