Enoxaparin, especially twice-daily, was linked to significantly higher major bleeding and mortality risks versus tinzaparin/dalteparin in cancer-associated VTE patients.
Does enoxaparin increase the risk of major bleeding compared to tinzaparin or dalteparin in patients with active cancer and acute VTE?
In patients with cancer-associated VTE, enoxaparin may carry a higher risk of bleeding and mortality compared to other low-molecular-weight heparins like tinzaparin or dalteparin.
Background: Low-molecular-weight heparins (LMWHs) are widely used in the treatment of cancer-associated venous thromboembolism (VTE), yet their long-term safety profiles remain insufficiently compared in clinical practice. Objectives: The primary outcome was major bleeding over a 6-month follow-up. Secondary outcomes included VTE recurrence, non-major clinically relevant bleeding, and all-cause mortality. Methods: We analyzed 7287 patients with active cancer and acute VTE from the RIETE registry (2009-2022) who were treated with full-dose enoxaparin ( = 5628) or tinzaparin/dalteparin ( = 1659). Analyses were adjusted using multivariable Cox models, Fine-Gray competing risk models, frailty models clustered by center, and propensity score approaches. Conclusion: In this large, observational study, enoxaparin, particularly in twice-daily regimens, was associated with significantly increased risks of bleeding and mortality compared to tinzaparin/dalteparin. These findings may help refine LMWH selection and dosing strategies in patients with cancer-associated VTE and warrant further investigation in prospective studies.
Monreal et al. (2025) studied this question. Enoxaparin, especially twice-daily, was linked to significantly higher major bleeding and mortality risks versus tinzaparin/dalteparin in cancer-associated VTE patients.
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