Comparative Efficacy and Safety of Direct Oral Anticoagulants Versus Low-Molecular-Weight Heparin in Cancer-Associated Thrombosis

International Journal of Medical Advances and Discoveries | Vol. 16, No. 11, November 2025 | pp. 77–85

DOI: 10.46882/2025/IJMAD/000110

Original Research Article

Title: Comparative Efficacy and Safety of Direct Oral Anticoagulants Versus Low-Molecular-Weight Heparin in Cancer-Associated Thrombosis

Names of Authors: Helena S. Vance¹, Klaus M. Brand², Jonathan R. Cross¹

Authors’ Affiliations: ¹Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; ²Department of Internal Medicine, Ludwig-Maximilians-Universität, Munich, Germany

Abstract: Cancer-associated thrombosis (CAT) increases the risk of mortality and recurrent venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) has long served as standard first-line management, but direct oral anticoagulants (DOACs) offer an attractive oral option. This multi-center, open-label, randomized non-inferiority trial evaluated the clinical outcomes of a next-generation DOAC, apixaban, compared to dalteparin (LMWH) over a 6-month treatment phase in 540 cancer patients presenting with acute symptomatic or incidental VTE. The primary efficacy endpoint was recurrent VTE, while safety endpoints measured major bleeding and clinically relevant non-major bleeding (CRNMB). Recurrent VTE occurred in 3.7% (10 of 270) of patients in the apixaban arm compared to 6.3% (17 of 270) in the dalteparin arm, satisfying the non-inferiority criteria (Hazard Ratio = 0.58, 95% Confidence Interval [0.31, 1.07], p < 0.001 for non-inferiority). Major bleeding events were comparable between groups, occurring in 2.2% of the apixaban cohort and 2.6% of the dalteparin cohort (p = 0.78). However, CRNMB rates were slightly higher in the apixaban treatment arm (6.7% vs 4.1%, p = 0.12), predominantly localized within patients presenting with unresected gastrointestinal malignancies. Patient-reported treatment satisfaction scales were significantly higher for oral apixaban (p < 0.001). Apixaban is an effective and safe oral alternative to dalteparin for CAT treatment.

Keywords: Cancer-associated thrombosis, Venous thromboembolism, Direct oral anticoagulants, Apixaban, Dalteparin, Major bleeding

Manuscript Timeline: Received: August 18, 2025; Revised: September 29, 2025; Accepted: October 15, 2025; Published: November 20, 2025

Citation: Vance, S. H., Brand, M. K., & Cross, R. J. (2025). Comparative Efficacy and Safety of Direct Oral Anticoagulants Versus Low-Molecular-Weight Heparin in Cancer-Associated Thrombosis. International Journal of Medical Advances and Discoveries, 16(11), 77–85. doi.org

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