Exploratory assessment of bleeding risk associated with concurrent use of Anti-VEGF agents and anticoagulants in oncology

Background: The concurrent use of anti-vascular endothelial growth factor (VEGF) agents and anticoagulants has become increasingly unavoidable in oncology, while the associated bleeding risk remains poorly characterized. Methods: A retrospective analysis combined with pharmacovigilance assessment was conducted to assess the associated bleeding risk. Patients who received concurrent use of anti-VEGF agents and anticoagulants at Hunan Cancer Hospital between 1 January 2010, and 1 October 2025, were included. Data on demographics, safety and duration of co-administration were collected. Additionally, drug-drug interaction signals were analyzed using FDA Adverse Event Reporting System (FAERS) (Q1, 2013 - Q4, 2024) via Ω shrinkage measure. Results: = 0.06). Conclusion: TKI-DOAC/LMWH and Bev-DOAC co-administration appeared to be safe, especially with short-term, prophylactic anticoagulant dosage. Given a potential bleeding signal, Bev-LMWH co-administration requires rigorous clinical monitoring. Owing to the hypothesis-generating nature of our study, definitive safety or causality require prospective validation.