Anticoagulant Treatment Patterns and Outcomes in Patients with Venous Thromboembolism and Active Cancer - a Nationwide Cohort Study in France

BACKGROUND: Cancer is a major risk factor for venous thromboembolism (VTE) and for all-cause mortality following a VTE event. Higher risk can be attributed to certain cancer types and to metastatic disease. Until recently the gold standard for VTE and active cancer was low molecular weight heparin (LMWH), shown to be superior to warfarin in preventing thrombosis (Lee et al. 2003). Previously only minimal data from the direct oral anticoagulant (DOAC) pivotal RCTs were available in this population. However recent RCTs have been conducted that provide rationale for the use of DOACs as an alternative to LMWH in this patient group (Agnelli et al. 2020; Raskob et al. 2018; Young et al. 2018). This evidence is reflected in international guidelines (ASH 2021; ESC 2019; ITAC 2019, NCCN 2021) where DOACs are now proposed in VTE and active cancer patients without gastrointestinal cancer.