Use of Direct Oral Anticoagulants in Cancer-Associated Thrombosis and Thrombocytopenia

BACKGROUND: Patients with cancer-associated thrombosis (CAT) are at increased risk of bleeding owing to both treatment- and disease-related thrombocytopenia. While the direct oral anticoagulants (DOACs) are used in the management of CAT, heparin continues to be recommended for patients with CAT and thrombocytopenia. METHODS: We performed a retrospective chart review of adult patients at Windsor Regional Hospital with CAT and thrombocytopenia (platelet count <100,000/mcL within 14 days of CAT), treated with DOACs or heparin. Patient progress was monitored for 100 days following venous thromboembolism (VTE) diagnosis. Primary outcomes included rates of recurrent VTE and bleeding. RESULTS: Forty-two patients met our inclusion criteria. In patients treated with DOACs, there were no recurrent VTE events and 4 bleeding events (25%), while those treated with heparin had 1 recurrent VTE (3.8%) and 3 bleeding events (11.5%). CONCLUSIONS: Rates of recurrent thrombosis and major bleeding were largely equivocal among thrombocytopenic patients with CAT treated with DOACs or heparins, suggesting that DOACs might be a feasible option in this population. Further research is needed to determine the optimal management of patients with cancer-associated VTE and thrombocytopenia. In addressing the complex landscape of cancer-associated thrombosis treatment, our research directly contributes to achieving United Nations Sustainable Development Goal #3, promoting healthy lives and well-being globally. By exploring alternative options for thrombocytopenic patients, our findings strive to enhance access to effective healthcare interventions, aligning with the shared vision of a healthier and more equitable world.