Journal: Thrombosis and haemostasis
This territory-wide Taiwanese cohort study evaluated adults with cancer-associated thrombosis initially treated with low–molecular-weight heparin (LMWH) between 2013–2021, comparing those who switched to a direct oral anticoagulant (DOAC) within 6 months versus those who continued LMWH.
Among 3,885 LMWH-treated patients (mean age ~66 years; 54% female), 2,373 (59.5%) transitioned to a DOAC. Using weighted Cox and competing-risk models, the authors found:
- Recurrent VTE: No significant difference between switchers and persistent LMWH users (HR 0.86; 95% CI 0.50–1.49).
- Major bleeding: No significant difference (HR 0.89; 95% CI 0.67–1.18).
- All-cause mortality: Significantly lower in those switched to a DOAC (HR 0.67; 95% CI 0.52–0.86).
These findings suggest that, in real-world practice, transitioning from LMWH to a DOAC in patients with cancer-associated thrombosis appears as safe and effective as continued LMWH with respect to VTE recurrence and major bleeding, and is associated with lower mortality.
The results were consistent irrespective of initial LMWH duration, total anticoagulation duration, and across clinically vulnerable subgroups.