Oncology · Hematology · 8 h ago
DOAC initiation for cancer-associated VTE increased in France, but remained lower
A nationwide cohort study of 683,184 adults with a first treated venous thromboembolism (VTE) in France found that direct oral anticoagulant (DOAC) initiation rose from 15.3% in 2016–2018 to 32.6% in 2021–2022 among patients with active cancer. Uptake remained below that in patients without active cancer and varied by clinical characteristics and prescriber setting.
- DOAC initiation rose to 32.6% among patients with active cancer.
- Uptake remained lower than in patients without active cancer.
- Clinical factors and prescriber setting were associated with initiation.
This nationwide population-based cohort study used French National Health Data System claims data, covering approximately 99% of the population. It included adults without recorded DOAC contraindications who had a first treated VTE between January 2016 and December 2022. The primary outcome was DOAC initiation within 30 days. Of 683,184 patients, 91,954 had active cancer and 591,230 did not.
Among patients with active cancer, DOAC initiation increased from 15.3% (95% CI, 15.0%–15.7%) in 2016–2018 to 32.6% (95% CI, 32.1%–33.2%) in 2021–2022. The corresponding increase among patients without active cancer was from 63.5% to 81.1%. In the active-cancer group, initiation rose beyond expected secular trends, with relative increases of 20.5% in 2019–2020 and 41.3% in 2021–2022.
DOAC use was less frequent in patients with comorbidities, prior bleeding, gastrointestinal or gynecologic cancer, active brain metastases, or systemic treatment, and when the initial prescriber was hospital-based rather than a general practitioner. These observational findings describe prescribing patterns, not comparative treatment effects; the lower uptake may reflect both implementation delays and individualized anticoagulant selection in complex clinical situations.
In practice
For adults with cancer-associated VTE in France, DOAC initiation within 30 days became more common over 2016–2022, but remained substantially less frequent than among patients without active cancer. Use was particularly lower in several clinically complex groups, including patients with prior bleeding, gastrointestinal or gynecologic cancer, active brain metastases, or systemic treatment. These claims-based observational data describe uptake rather than comparative safety or effectiveness and do not establish that treatment selection should change; individual clinical factors remain relevant.
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JAMA Network Open: Trends in Direct Oral Anticoagulant Use for Cancer-Associated Venous Thromboembolism ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.