DOACs on par with LMWH at preventing VTE in cancer patients

Cancer patients receiving either low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) show comparable frequency of venous thromboembolism (VTE), reports a recent study.

“VTE is the second leading cause of death in patients with malignancy,” the investigators said. “The currently available guidelines have shown greater support for utilization of LMWH over DOACs in cancer-associated VTE.”

To assess the safety and efficacy of DOACs compared to LMWH, the investigators performed a retrospective review of outpatient records and identified patients with documented cancer diagnosis and either a DOAC or LMWH as a listed medication.

Patients were not included in the study if they had atrial fibrillation, valvular disease, antiphospholipid antibody syndrome, current pregnancy, body mass index (BMI) >40 kg/m² or weight >120 kg, severe renal or hepatic impairment, or were on concomitant therapy with a significant interacting medication.

A total of 156 patients with cancer met the eligibility criteria, of whom 78 were on DOAC and 78 on LMWH. The primary outcome of frequency of VTE recurrence did not significantly differ between patients in the DOAC and LMWH groups (5 vs 8: 6.4 percent vs 10.3 percent; p=0.39).

Likewise, no significant between-group difference was noted in the secondary outcomes of major or minor bleeding as well as other thrombotic events.

“DOACs may be [used as] an alternative agent to LMWH for the prevention of recurrent VTE in patients with cancer,” the investigators said.