Direct Oral Anticoagulants Versus Low-Molecular-Weight Heparin for Treating Venous Thromboembolism in Patients With Gastrointestinal Cancer

Q: What is the study’s main objective when comparing DOACs and LMWH?

The study compares risks of recurrent thromboembolism and bleeding between patients with gastrointestinal cancer treated with DOACs versus LMWH.

Q: How were outcomes measured in this study?

Recurrent VTE and major bleeding were assessed using inverse probability weighting and Cox proportional hazards models, with death handled as a competing risk via a competing-risk model.

Q: What did the results show regarding recurrent VTE and bleeding?

Recurrent VTE risk was higher with DOACs than enoxaparin, while composite bleeding risk was similar. DOACs showed increased GI bleeding risk and reduced intracranial hemorrhage risk compared with LMWH.

Sep 23, 2026

Uploaded by Aria Callaghan

Direct oral anticoagulants (DOACs) show non-inferiority to low-molecular-weight heparin (LMWH) for preventing recurrent venous thromboembolism (VTE) in cancer-associated thrombosis, yet gastrointestinal (GI) cancer patients receiving DOACs have reported more major bleeding. This study compares recurrent thromboembolism and bleeding outcomes between DOAC and LMWH users in GI cancer patients using Taiwan’s National Health Insurance Research Database with inverse probability weighting and Cox models plus a competing-risk death analysis over 12 months.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Methods

Results

Conclusions

Cancer Medicine | RESEARCH ARTICLE OPEN ACCESS
Direct Oral Anticoagulants Versus Low-Molecular-Weight Heparin for Treating Venous Thromboembolism in Patients With Gastrointestinal Cancer
Wei-Ting Chang1,2,3 | Mei-Chuan Lee4,5,6 | Hui-Wen Lin7 | Sheng-Hsiang Lin6,8,9 | Yi-Heng Li7
1School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan | 2Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan | 3School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan | 4Department of Pharmacy, Chi Mei Medical Center, Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan | 5Biostatistics Consulting Center, National Cheng Kung University, Tainan, Taiwan | 6Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan | 7Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan | 8Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan | 9Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Correspondence: Yi-Heng Li ([cmcvecho1@gmail.com](cmcvecho1@gmail.com))
Received: 28 May 2025 | Revised: 30 March 2026 | Accepted: 7 April 2026
Keywords: gastrointestinal cancer | low molecular-weight heparin | oral anticoagulants | venous thromboembolism | | --- | | ABSTRACT
Background: Direct oral anticoagulants (DOACs) have demonstrated non-inferiority to low-molecular-weight heparin (LMWH) for preventing recurrent venous thromboembolism (VTE) in cancer-associated thrombosis. However, patients with gastrointestinal (GI) cancer receiving DOACs have reported increased major bleeding events. Hereby, we aim to compare the risks of recurrent thromboembolism and bleeding between those treated with DOACs and LMWH.
Methods: Using Taiwan's National Health Insurance Research Database, we retrospectively identified GI cancer patients with newly diagnosed VTE from 2011 to 2020. Outcomes were recurrent VTE and major bleeding. Covariate balancing was performed using inverse probability weighting, and Cox proportional hazards models compared risks, with a competing risk model for death. Follow-up was 12 months.
Results: Among 1895 patients (1038 on DOACs, 857 on enoxaparin), recurrent VTE occurred in 20.71% of DOAC and 19.25% of enoxaparin patients. Competing risk analysis showed relatively higher recurrent VTE risk with DOACs (subdistribution HR, 1.27; 95% CI, 1.09–1.48; p< 0.01) . Regarding composite bleeding risk, DOACs were similar compared with LMWH (subdistribution HR, 0.99; 95% CI, 0.68–1.45; p = 0.97) . However, DOACs presented with an increased GI bleeding risk (subdistribution HR, 2.59; 95% CI, 1.48–4.54; p < 0.01) but a reduced intracranial hemorrhage risk (subdistribution HR, 0.35; 95% CI, 0.16–0.78; p = 0.01) .
Conclusions: Compared with DOACs, LMWH expressed a lower risk of recurrent VTE in GI cancer patients. However, DOAC presented with a lower intracranial hemorrhage risk but a higher GI bleeding risk. Further research is needed to confirm these findings. | | | | Wei-Ting Chang and Mei-Chuan Lee contributed equally to this article.
Sheng-Hsiang Lin and Yi-Heng Li contributed equally to this article. | | This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2026 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd. | Cancer Medicine, 2026; 15:e71838 1 of 10 [https://doi.org/10.1002/cam4.71838](

FAQs

What is the study’s main objective when comparing DOACs and LMWH?

The study compares risks of recurrent thromboembolism and bleeding between patients with gastrointestinal cancer treated with DOACs versus LMWH.

How were outcomes measured in this study?

Recurrent VTE and major bleeding were assessed using inverse probability weighting and Cox proportional hazards models, with death handled as a competing risk via a competing-risk model.

What did the results show regarding recurrent VTE and bleeding?

Recurrent VTE risk was higher with DOACs than enoxaparin, while composite bleeding risk was similar. DOACs showed increased GI bleeding risk and reduced intracranial hemorrhage risk compared with LMWH.

Sep 23, 2026

Uploaded by Aria Callaghan