Clinical characteristics and outcomes of anticoagulant therapy in Malaysian patients with venous thromboembolism: a single-center retrospective study

Over the last decade, incidence of venous thromboembolism (VTE) has risen in Asia, leading to increased anticoagulant use. This study evaluated baseline demographics and clinical features of VTE, along with the safety and efficacy of anticoagulant use in Malaysian patients. This was a single-centre retrospective cohort study of adult VTE patients conducted from January 2016 to December 2020. A total of 800 patients with VTE treated with direct oral anticoagulants (DOACs) ( n = 508, 63.5%), warfarin ( n = 100, 12.5%) or low-molecular-weight heparin (LMWH) ( n = 192, 24.0%) were included. Most had deep vein thrombosis (DVT) or pulmonary embolism (PE) (91.1%). Major bleeding was lowest in DOACs (7.3%) with similar rates between LMWH and warfarin (12.0% vs. 11.0%). Clinically relevant non-major bleeding (CRNMB) rates were highest with DOACs (6.3%). Recurrent VTE was more frequent with warfarin (7.0%), followed by DOACs (6.7%), and LMWH (2.6%). Compared to warfarin, there was no significant difference in hazard for major bleeding with DOACs (HR 0.67, 95%CI 0.34–1.31, p = 0.236) and recurrent VTE in LMWH and DOACs (HR 0.40, 95% CI 0.11–1.36, p = 0.141 vs. 0.49, 95% CI 0.18–1.34, p = 0.163). However, LMWH showed significantly higher hazards in major bleeding (HR 2.50, 95%CI 1.19–5.21, p = 0.015), CRNMB (HR 9.67, 95%CI 1.17–79.88, p = 0.035) and all-cause mortality (HR 4.45, 95% CI 2.94–6.73, p < 0.001) compared to warfarin. The anticoagulants showed similar efficacy in preventing recurrent VTE. Although DOAC therapy was associated with a lower adjusted hazard of major bleeding and a trend toward higher hazard of CRNMB, this did not reach statistical significance. Critically ill patients at higher bleeding risk received LMWH resulting in higher adjusted hazard of major bleeding, CRNMB and all-cause mortality.