Direct oral anticoagulants <i>vs</i> LMWH for cancer-associated thrombosis - updated evidence on bleeding risk, recurrence and patient-reported outcomes: A systematic review

BACKGROUND: Cancer increases the risk of developing dangerous and sometimes deadly blood clots, which are known as cancer-associated thrombosis (CAT). While direct oral anticoagulants (DOACs) can be considered for CAT, evidence is limited regarding their use in comparison to low molecular weight heparin (LMWH). AIM: To compare the efficacy, bleeding risks, reoccurrence rate, and patient-reported outcomes of DOACs compared to LMWH in CAT of different cancer types. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist was followed during the search and screening of publications. Articles were searched systematically through biomedical databases such as PubMed, Scopus, and Cochrane covering studies published from January 1, 2003 to December 31, 2024. Articles were carefully chosen and studied according to the set Population Intervention Comparator Outcomes criteria. The research we analyzed examined the use of anticoagulants in cancer patients with venous thromboembolism (VTE) in comparison LMWH. The outcomes were cases of bleeding, VTE recurrence in patients, and their level of satisfaction with the treatment results. RESULTS: 29-39%), and medication adherence (15%-25% improvement). CONCLUSION: lower gastrointestinal cancers), the risk of bleeding, and the patient's preferences or abilities.