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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
    • The University of Hong Kong, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, Hong Kong SAR, China, ROR: https://ror.org/02zhqgq86, GRID: grid.194645.b, ISNI: 0000 0001 2174 2757
    • National University of Singapore, Department of Ophthalmology, Yong Loo Lin School of Medicine, Singapore, Singapore, ROR: https://ror.org/01tgyzw49, GRID: grid.4280.e, ISNI: 0000 0001 2180 6431
    • The University of Hong Kong-Shenzhen Hospital, Clinical Oncology Center, Shenzhen, China, GRID: grid.440671.0, ISNI: 0000 0004 5373 5131
    • The Chinese University of Hong Kong, State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Hong Kong Cancer Institute, Hong Kong SAR, China, GRID: grid.10784.3a, ISNI: 0000 0004 1937 0482
    • The University of Hong Kong, Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, Hong Kong SAR, China, ROR: https://ror.org/02zhqgq86, GRID: grid.194645.b, ISNI: 0000 0001 2174 2757
    • The University of Hong Kong-Shenzhen Hospital, Department of Pharmacy, Shenzhen, China, ROR: https://ror.org/047w7d678, GRID: grid.440671.0, ISNI: 0000 0004 5373 5131

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

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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.
    Original languageEnglish
    Article number5657
    Number of pages11
    JournalNature Communications
    Volume15
    Issue number1
    Early online date5 Jul 2024
    DOIs
    Publication statusPublished - 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/

    Funding

    This study was supported by the Hong Kong Research Grants Council, General Research Fund (GRF), No. 17108621, which was received by E.W.C. The funding source had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data. We thank the Hong Kong Hospital Authority for access to the data from the Clinical Database Analysis and Reporting System for research purposes and the Information Technology Services, The University of Hong Kong, for offering research computing facilities for the computations in this study. We thank Lisa Y Lam, MJ, Department of Pharmacology and Pharmacy, The University of Hong Kong, for proofreading the manuscript. Ms. Lam was compensated for her contribution.

    UN SDGs

    This output contributes to the following UN Sustainable Development Goals (SDGs)

    1. SDG 3 - Good Health and Well-being
      SDG 3 Good Health and Well-being

    Access to Document

    • 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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