Comparison of anticoagulants and risk of ischemic stroke in patients with acute cancer-associated venous thromboembolism
Year: 2025
Type: article
Study design: Observational Study
Abstract: ABSTRACT: Venous thromboembolism (VTE) is a frequent occurrence in patients with cancer. However, it is not known whether treatment with different classes of anticoagulants impacts the risk of subsequent arterial thromboembolism. We performed a retrospective, population-based cohort study using Surveillance, Epidemiology, and End Results data linked with Medicare claims. Patients were eligible for study inclusion if they had a diagnosis of primary brain, colorectal, gastric, pancreatic, lung, or ovarian cancer between 2007 and 2015, were diagnosed with VTE, and had a prescription claim for a direct oral anticoagulant (DOAC), low-molecular-weight heparin (LMWH), or warfarin. We matched patients by propensity score in a 1:1:1 ratio into anticoagulant treatment groups based on their baseline demographic information, cancer-specific characteristics, and cardiovascular comorbidities. The primary aim of the study was to determine and compare the 6-month cumulative incidence of ischemic stroke across anticoagulant classes. The study comprised 4875 total patients with 1625 in each treatment group. At 6 months, the cumulative incidence of ischemic stroke was 5.6% (95% confidence interval [CI], 5.0-6.3) overall and 6.8% (95% CI, 5.6-8.1) in the DOAC, 4.9% (95% CI, 3.9-6.0) in the LMWH, and 5.2% (95% CI, 4.1-6.2) in the warfarin treatment groups (P = .040). We identified hypertension (odds ratio [OR], 1.75), atrial fibrillation/flutter (OR, 1.37), DOAC use (OR, 1.36), and previous stroke (OR, 3.59) as statistically significant risk factors for ischemic stroke in the multivariable modeling. In conclusion, ischemic stroke is a common occurrence after cancer-associated VTE and may occur more frequently in patients treated with DOACs.
Source: Blood Advances
Institutions: University of California, San Francisco, Danbury Hospital, Mount Auburn Hospital, Harvard University, Albert Einstein College of Medicine, Jacobi Medical Center, University at Buffalo, State University of New York, National Jewish Health, Dana-Farber Cancer Institute, Thai Red Cross Society, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Hebrew SeniorLife, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, Beth Israel Deaconess Medical Center
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
Funders: Conquer Cancer Foundation, Bristol-Myers Squibb, Sanofi, California Department of Public Health, University of Southern California, CSL Behring, Incyte, National Institutes of Health, Centers for Disease Control and Prevention, University of California, San Francisco, National Cancer Institute
Awards: G1352184354, G1395202410, G2337224928, G2612351997, G3448447748, G3467199957, G3509688676, G4102770861, G4332884407, G4854421162, G504639888, G5631299761, G671936517, G6951404960, G7290139498, G8083727551, G8380263711, G8509442309, G9000003249, G9000055636, Cancer Center Support Grant, G946791773
OpenAlex ID: W4413420100