Real-world thrombotic and survival outcomes with ESAs in cancer-related anemia
Year: 2026
Type: article
Study design: Observational Study
Abstract: : Erythropoiesis-stimulating agents (ESAs) are commonly used to treat cancer-related anemia by increasing hemoglobin levels and reducing transfusion requirements. However, randomized trials and meta-analyses have linked ESA use to increased thrombotic risk. Contemporary real-world data across diverse cancer populations and ESA formulations remain limited. We conducted a retrospective cohort study using the TriNetX Research Network (January 1, 2015–July 31, 2024) evaluating adult patients with cancer-related anemia. Patients receiving ESAs were propensity score matched 1:1 with non-ESA patients based on demographics, cancer type, and comorbidities. Individuals with prior thrombotic events or anticoagulant use were excluded. Outcomes included incident deep vein thrombosis (DVT), pulmonary embolism (PE), new anticoagulant use, and 1-year survival. Risk differences, relative risks, and Kaplan-Meier survival analyses were performed. After matching, 1,606 patients were included in each cohort, with predominant cancer types including prostate, breast, bladder, colon, and kidney cancer. There was no significant difference in DVT (1.5% vs 2.1%; p=0.19) or PE (0.75% vs 1.1%; p=0.27) between ESA and non-ESA groups. New anticoagulant use was significantly lower in ESA-treated patients (6.3% vs 10.2%; RR 0.52, 95% CI 0.49–0.78; p<0.001). One-year survival was higher in the ESA cohort (73% vs 69%; HR 0.82, 95% CI 0.72–0.94; p=0.004). In this large real-world cohort, ESA use was not associated with increased short-term thrombotic risk and was associated with lower anticoagulant use and improved 1-year survival. These findings suggest that guideline-concordant ESA use may be safe in selected patients with cancer-related anemia.
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W7207584750