Comparative Effectiveness of Direct Oral Anticoagulants and Warfarin on Venous Thromboembolism in Cancer Patients

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2025-09-09 DOI:10.1002/cam4.71209

Hye-In Jung, Claudia Geue, Giorgio Ciminata, Eui-Kyung Lee

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Abstract

Introduction

Venous thromboembolism (VTE) is a leading cause of mortality in cancer patients, and a substantial number of patients are being treated with oral anticoagulants. We aim to assess the comparative effectiveness of direct oral anticoagulants (DOACs) compared to warfarin for VTE treatment in cancer patients.

Methods

In this retrospective cohort study, we included 2,367 cancer patients who are new users of oral anticoagulants (OACs) for VTE treatment from 2009 to 2021 in NHS Scotland. Patients were grouped by OAC type, DOACs or warfarin. To adjust for confounding, inverse probability treatment weighting was applied. Outcomes included mortality, VTE recurrence, and major bleeding. We calculated Hazard Ratio (HR) using Cox regression and sub-distribution HR (sHR) using a competing risk framework (Fine and Gray method) for VTE recurrence and major bleeding. Subgroup analyses were conducted for individual DOACs.

Results

Patients on DOACs had lower risks of VTE recurrence (sHR 0.73 95% CI 0.59–0.90) and major bleeding (sHR 0.68, 95% CI 0.53–0.88) compared to patients on warfarin. Patients on rivaroxaban (HR 1.21, 95% CI 1.04–1.39) and edoxaban (HR 1.59, 95% CI 1.15–2.22) had a significantly higher risk of mortality, while a comparable risk of mortality was observed (HR 0.91, 95% CI 0.76–1.08) for patients on apixaban compared to patients on warfarin.

Conclusion

This study provides insight into the effectiveness of DOACs compared to warfarin for VTE in cancer patients. Patients on DOACs had lower risks of VTE recurrence and major bleeding. We suggest healthcare professionals consider the potential benefits of individual DOACs when making treatment decisions.

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直接口服抗凝剂与华法林治疗癌症患者静脉血栓栓塞的疗效比较

静脉血栓栓塞（VTE）是癌症患者死亡的主要原因，大量患者正在接受口服抗凝剂治疗。我们的目的是评估直接口服抗凝剂（DOACs）与华法林在治疗癌症患者静脉血栓栓塞（VTE）中的比较效果。方法在这项回顾性队列研究中，我们纳入了2367名2009年至2021年在苏格兰NHS中首次使用口服抗凝剂（OACs）治疗静脉血栓栓塞的癌症患者。患者按OAC型、doac型或华法林进行分组。为校正混杂因素，采用逆概率加权处理。结果包括死亡率、静脉血栓栓塞复发和大出血。我们使用Cox回归计算静脉血栓栓塞复发和大出血的风险比（HR），并使用竞争风险框架（Fine and Gray法）计算亚分布风险比（sHR）。对个体doac进行亚组分析。结果与华法林组相比，DOACs组的静脉血栓栓塞复发风险（sHR 0.73, 95% CI 0.59-0.90）和大出血风险（sHR 0.68, 95% CI 0.53-0.88）较低。服用利伐沙班（HR 1.21, 95% CI 1.04-1.39）和依多沙班（HR 1.59, 95% CI 1.15-2.22）的患者死亡率风险显著高于服用阿哌沙班的患者（HR 0.91, 95% CI 0.76-1.08），而服用阿哌沙班的患者死亡率风险与服用华法林的患者相当（HR 0.91, 95% CI 0.76-1.08）。结论与华法林相比，本研究提供了DOACs治疗癌症患者静脉血栓栓塞的有效性。DOACs患者静脉血栓栓塞复发和大出血的风险较低。我们建议医疗保健专业人员在作出治疗决定时考虑个别doac的潜在益处。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.