Switching Cancer-associated Venous Thromboembolism Treatment from Continuous LMWH to DOACs: An Evaluation

Although direct oral anticoagulants (DOACs) have become a primary treatment choice for cancer-associated venous thromboembolism (CT), the safety and effectiveness of switching from low-molecular-weight heparin (LMWH) to DOACs in current users remains unclear.To evaluate the safety and effectiveness of switching to DOACs in patients with CT currently receiving LMWH therapy, a territory-wide cohort study using linked claims and registry databases in Taiwan was conducted. Between 2013 and 2021, patients with CT were identified and categorized as switchers to DOACs versus persistent LMWH users. Cox regression and Fine-Gray models with inverse probability of treatment weighting were used to estimate hazard ratios (HRs) for recurrent venous thromboembolism (VTE), major bleeding, and all-cause mortality.A total of 3,885 patients with LMWH-treated CT were included, with 2,103 (54.1%) being women and a mean age of 65.6 years at CT diagnosis, of which 2,373 (59.5%) switched to DOAC therapy. Compared with the persistent use of LMWH, switching to DOACs within 6 months was associated with no significant difference in recurrent VTE (HR: 0.86 [95% CI 0.50-1.49]) and major bleeding (HR: 0.89 [95% CI 0.67-1.18]), with a significantly lower risk of all-cause mortality (HR: 0.67 [95% CI 0.52-0.86]).Switching to DOACs is a safe and effective alternative to continuous LMWH in patients with CT. This recommendation applies regardless of the duration of initial LMWH therapy, overall treatment duration, and across various vulnerable patient groups.