Effectiveness and safety of continuous low-molecular-weight heparin versus switching to direct oral anticoagulants in cancer-associated venous thrombosis

Wei Kang; Caige Huang; Vincent K. C. Yan; Yue Wei; Jessica J. P. Shami; Silvia T. H. Li; Yu Yang; Xuxiao Ye; Junhan Tang; Shing Fung Lee; Victor H. F. Lee; Stephen L. Chan; Aya El Helali; Ka On Lam; Roger K. C. Ngan; Ian C. K. Wong; Esther W. Chan

doi:10.1038/s41467-024-50037-1

Effectiveness and safety of continuous low-molecular-weight heparin versus switching to direct oral anticoagulants in cancer-associated venous thrombosis

Wei Kang, Caige Huang, Vincent K. C. Yan, Yue Wei, Jessica J. P. Shami, Silvia T. H. Li, Yu Yang, Xuxiao Ye, Junhan Tang, Shing Fung Lee, Victor H. F. Lee, Stephen L. Chan, Aya El Helali, Ka On Lam, Roger K. C. Ngan, Ian C. K. Wong, Esther W. Chan^*

^*Corresponding author for this work

Aston Pharmacy School

Research output: Contribution to journal › Article › peer-review

Abstract

Given the existing uncertainty regarding the effectiveness and safety of switching from low-molecular-weight heparin (LMWH) to direct oral anticoagulants (DOACs) in patients with cancer-associated venous thrombosis (CAT), we conducted a comprehensive population-based cohort study utilizing electronic health database in Hong Kong. A total of 4356 patients with CAT between 2010 and 2022 were included, with 1700 (39.0%) patients switching to DOAC treatment. Compared to continuous LMWH treatment, switching to DOACs was associated with a significantly lower risk of hospitalization due to venous thromboembolism (HR: 0.49 [95% CI = 0.35–0.68]) and all-cause mortality (HR: 0.67 [95% CI = 0.61–0.74]), with no significant difference in major bleeding (HR: 1.04 [95% CI = 0.83–1.31]) within six months. These findings provide reassurance regarding the effectiveness and safety of switching from LMWH to DOACs among patients with CAT, including vulnerable patient groups.

Original language	English
Article number	5657
Number of pages	11
Journal	Nature Communications
Volume	15
Issue number	1
Early online date	5 Jul 2024
DOIs	https://doi.org/10.1038/s41467-024-50037-1
Publication status	Published - Dec 2024

Bibliographical note

Copyright © The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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10.1038/s41467-024-50037-1

Wei Kang et al_Effectiveness and safety of continuous low-molecular-weight-heparin_vs direct oral anticoagulants in cancer-assoc venous thrombosis
Copyright © The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/
Final published version, 914 KBLicence: CC BY 4.0

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Kang, W., Huang, C., Yan, V. K. C., Wei, Y., Shami, J. J. P., Li, S. T. H., Yang, Y., Ye, X., Tang, J., Lee, S. F., Lee, V. H. F., Chan, S. L., El Helali, A., Lam, K. O., Ngan, R. K. C., Wong, I. C. K., & Chan, E. W. (2024). Effectiveness and safety of continuous low-molecular-weight heparin versus switching to direct oral anticoagulants in cancer-associated venous thrombosis. Nature Communications, 15(1), Article 5657. https://doi.org/10.1038/s41467-024-50037-1

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abstract = "Given the existing uncertainty regarding the effectiveness and safety of switching from low-molecular-weight heparin (LMWH) to direct oral anticoagulants (DOACs) in patients with cancer-associated venous thrombosis (CAT), we conducted a comprehensive population-based cohort study utilizing electronic health database in Hong Kong. A total of 4356 patients with CAT between 2010 and 2022 were included, with 1700 (39.0%) patients switching to DOAC treatment. Compared to continuous LMWH treatment, switching to DOACs was associated with a significantly lower risk of hospitalization due to venous thromboembolism (HR: 0.49 [95% CI = 0.35–0.68]) and all-cause mortality (HR: 0.67 [95% CI = 0.61–0.74]), with no significant difference in major bleeding (HR: 1.04 [95% CI = 0.83–1.31]) within six months. These findings provide reassurance regarding the effectiveness and safety of switching from LMWH to DOACs among patients with CAT, including vulnerable patient groups.",

author = "Wei Kang and Caige Huang and Yan, {Vincent K. C.} and Yue Wei and Shami, {Jessica J. P.} and Li, {Silvia T. H.} and Yu Yang and Xuxiao Ye and Junhan Tang and Lee, {Shing Fung} and Lee, {Victor H. F.} and Chan, {Stephen L.} and {El Helali}, Aya and Lam, {Ka On} and Ngan, {Roger K. C.} and Wong, {Ian C. K.} and Chan, {Esther W.}",

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Kang, W, Huang, C, Yan, VKC, Wei, Y, Shami, JJP, Li, STH, Yang, Y, Ye, X, Tang, J, Lee, SF, Lee, VHF, Chan, SL, El Helali, A, Lam, KO, Ngan, RKC, Wong, ICK & Chan, EW 2024, 'Effectiveness and safety of continuous low-molecular-weight heparin versus switching to direct oral anticoagulants in cancer-associated venous thrombosis', Nature Communications, vol. 15, no. 1, 5657. https://doi.org/10.1038/s41467-024-50037-1

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AU - Kang, Wei

AU - Huang, Caige

AU - Yan, Vincent K. C.

AU - Wei, Yue

AU - Shami, Jessica J. P.

AU - Li, Silvia T. H.

AU - Yang, Yu

AU - Ye, Xuxiao

AU - Tang, Junhan

AU - Lee, Shing Fung

AU - Lee, Victor H. F.

AU - Chan, Stephen L.

AU - El Helali, Aya

AU - Lam, Ka On

AU - Ngan, Roger K. C.

AU - Wong, Ian C. K.

AU - Chan, Esther W.

N1 - Copyright © The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

PY - 2024/12

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N2 - Given the existing uncertainty regarding the effectiveness and safety of switching from low-molecular-weight heparin (LMWH) to direct oral anticoagulants (DOACs) in patients with cancer-associated venous thrombosis (CAT), we conducted a comprehensive population-based cohort study utilizing electronic health database in Hong Kong. A total of 4356 patients with CAT between 2010 and 2022 were included, with 1700 (39.0%) patients switching to DOAC treatment. Compared to continuous LMWH treatment, switching to DOACs was associated with a significantly lower risk of hospitalization due to venous thromboembolism (HR: 0.49 [95% CI = 0.35–0.68]) and all-cause mortality (HR: 0.67 [95% CI = 0.61–0.74]), with no significant difference in major bleeding (HR: 1.04 [95% CI = 0.83–1.31]) within six months. These findings provide reassurance regarding the effectiveness and safety of switching from LMWH to DOACs among patients with CAT, including vulnerable patient groups.

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Effectiveness and safety of continuous low-molecular-weight heparin versus switching to direct oral anticoagulants in cancer-associated venous thrombosis

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