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Thromb Haemost
DOI: 10.1055/a-2785-8686
Original Article: Stroke, Systemic or Venous Thromboembolism

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

Autor*innen

  • Wei Kang    ‡

    1   School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
    2   Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

  • Chin-Yao Shen    ‡

    3   School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    4   Population Health Data Center, National Cheng Kung University, Tainan, Taiwan

  • Michael Chun-Yuan Cheng 

    3   School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    4   Population Health Data Center, National Cheng Kung University, Tainan, Taiwan

  • Vincent K. C. Yan 

    2   Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

  • Shing Fung Lee 

    5   Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
    6   Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

  • Wei-Pang Chung 

    7   Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    8   Center for Applied Nanomedicine, National Cheng Kung University, Tainan, Taiwan

  • Caige Huang 

    2   Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

  • Silvia T. H. Li 

    2   Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

  • Yue Wei 

    2   Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

  • Victor H. F. Lee 

    9   Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
    10   Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

  • Stephen L. Chan 

    11   State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong SAR, China

  • Ka On Lam 

    9   Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
    10   Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

  • Aya El Helali 

    9   Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

  • Edward Chia-Cheng Lai 

    3   School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    4   Population Health Data Center, National Cheng Kung University, Tainan, Taiwan

  • Esther W. Chan 

    2   Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
    12   The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
    13   Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

Funding Information The Hong Kong Research Grants Council, General Research Fund (GRF) (Grant No. 17108621) provided support for this study. The funding source played no part in the study design, execution, management, data analysis, and interpretation.
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Graphical Abstract

Abstract

Background

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.

Methods

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.

Results

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]).

Conclusion

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.

Keywords

cancer-associated venous thrombosis (CT) - direct oral anticoagulants (DOACs) - low-molecular-weight heparin (LMWH) - venous thromboembolism (VTE) - major bleeding

Data Availability Statement

As the data utilized in this study were anonymized, informed patient consent was not required. The datasets generated or analyzed in this study are not publicly accessible due to the data protection policy of the National Health Insurance Research Database (https://nhird.nhri.org.tw/en/Data_Protection.html). Researchers wishing to analyze these datasets must submit a formal application to the Taiwan Ministry of Health and Welfare for access. For more information, please visit their Web site at https://dep.mohw.gov.tw/DOS/cp-5119-59201-113.html.


Contributors' Statement

W.K. and E.W.C.: conception and design; W.K., C.Y.S., C.Y.C., and E.W.C.: acquisition, analysis, or interpretation of data; W.K.: drafting of the manuscript; W.K., C.Y.C., and C.H.: statistical analysis; E.W.C. and E.C.C.L.: dministrative, technical, or material support; E.W.C. and E.C.C.L.: supervision. All the authors critically revised the manuscript for important intellectual content. All the authors reviewed the manuscript.


‡ These authors contributed equally to the work.


Supplementary Material



Publikationsverlauf

Eingereicht: 11. Juli 2025

Angenommen nach Revision: 10. Januar 2026

Artikel online veröffentlicht:
30. Januar 2026

© 2026. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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