Venous Thromboembolism in Cancer: Predictors of Recurrence and Bleeding in Patients on Direct Oral Anticoagulants

TL;DR

This study examines how cancer patients on DOACs for blood clots are affected by factors like kidney function and medication use.

Contribution

The study identifies specific clinical predictors of VTE recurrence and bleeding in cancer patients using DOACs.

Findings

7.5% of patients experienced VTE recurrence within six months.

Dexamethasone and reduced kidney function increased major bleeding risk.

NSAID use was linked to higher CRNMB risk in cancer patients on DOACs.

Abstract

Introduction: Cancer patients are at a heightened risk of veous thromboembolism (VTE) and bleeding complications. Direct oral anticoagulants (DOACs) are increasingly used due to their oral administration and lack of routine monitoring. However, factors such as drug interactions, chemotherapy, tumor location, and renal function may influence their safety and efficacy. This study evaluates clinical predictors of VTE recurrence and bleeding outcomes in cancer patients on DOAC therapy. Methods: A multicenter retrospective cohort study included 160 adult cancer patients treated with DOACs for VTE. Data on demographics, clinical characteristics, and outcomes—including VTE recurrence, major bleeding, minor bleeding, and clinically relevant non-major bleeding (CRNMB)—were analyzed. Logistic regression identified predictors of outcomes, with significance set at p < 0.05. Results: At six months, VTE recurrence occurred in 7.5% of patients, while major bleeding and CRNMB were observed in 6.3% and minor bleeding in 8.8%. Decreased creatinine clearance (OR = 0.957, p = 0.024) and dexamethasone use (OR = 18.03, p = 0.031) were significant predictors of major bleeding. NSAID use (OR = 12.37, p = 0.009) increased CRNMB risk. Major bleeding at 12 months was significantly associated with recurrent VTE (χ2(1, N = 160) = 10.03, p = 0.002). Conclusions: DOACs are effective for VTE in cancer patients, but careful monitoring of renal function and dexamethasone use is essential due to increased bleeding risk. Caution is advised with NSAIDs in this population.