Effectiveness and Safety of Anticoagulants Among Patients with Venous Thromboembolism and Common Cancers or Cancers with High Venous Thromboembolism Risk

<b>Aim:</b> Treatment effects among anticoagulant-treated patients with venous thromboembolism (VTE) and cancer across tumor types were evaluated. <b>Methods:</b> Patients initiating an anticoagulant within 30 days after VTE were identified. After inverse probability treatment weighting, patients were stratified by tumor type. Interactions between treatment and tumor type on recurrent VTE, major bleeding and clinically relevant non-major bleeding were assessed using Cox proportional hazard models. <b>Results:</b> Treatment effects were generally not significantly different among patients with or without the following cancer types: prostate, breast, lung, pancreatic or multiple myeloma. Few significant interactions were observed for lung and pancreatic cancer. <b>Conclusion:</b> Anticoagulant treatment effects were generally consistent across tumor types. The significant interactions may indicate tumor-specific effects of anticoagulants, but further research is needed. This real-world study evaluated the effectiveness and safety of apixaban, LMWH, and warfarin among patients with VTE and with common or high risk tumor type. Further research is needed to better understand effects of anticoagulants in patients with VTE and different tumor types

研究目的：本研究旨在评估不同肿瘤类型下，合并癌症的静脉血栓栓塞症（venous thromboembolism, VTE）患者接受抗凝治疗后的治疗效应。研究方法：筛选出在确诊VTE后30天内启动抗凝治疗的患者。经逆概率治疗加权（inverse probability treatment weighting）后，按肿瘤类型对患者进行分层。采用Cox比例风险模型（Cox proportional hazard models），评估治疗方式与肿瘤类型对复发性VTE、大出血及临床相关非大出血的交互作用。研究结果：在前列腺癌、乳腺癌、肺癌、胰腺癌及多发性骨髓瘤患者与非上述癌症患者群体中，抗凝治疗的总体效应未呈现显著差异。仅在肺癌及胰腺癌患者中观察到少量显著交互作用。研究结论：抗凝治疗的效应在不同肿瘤类型间总体保持一致。上述显著的交互作用或提示抗凝治疗存在肿瘤特异性效应，但仍需开展进一步研究加以验证。本项真实世界研究评估了阿哌沙班（apixaban）、低分子量肝素（Low Molecular Weight Heparin, LMWH）及华法林（warfarin）在合并常见或高风险肿瘤类型的VTE患者中的有效性与安全性。未来仍需开展更多研究，以更深入地阐明抗凝治疗在VTE合并不同肿瘤类型患者中的作用效果。