Characteristics and outcomes of patients on concurrent direct oral anticoagulants and targeted anticancer therapies—TacDOAC registry: Communication from the ISTH SSC Subcommittee on Hemostasis and Malignancy

Tzu Fei Wang*, Lisa Baumann Kreuziger, Avi Leader, Galia Spectre, Ming Y. Lim, Andrew Gahagan, Radhika Gangaraju, Kristen M. Sanfilippo, Ranjeeta Mallick, Jeffrey I. Zwicker, Marc Carrier

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cancer patients are increasingly prescribed direct oral anticoagulants (DOACs) and targeted anticancer therapies, but limited data are available on the outcomes during concurrent use. Objectives: We conducted an international registry through the Scientific and Standardization Committee of the ISTH to evaluate the characteristics, bleeding, and thrombotic outcomes in patients receiving concurrent DOACs and targeted anticancer therapies. Patients/Methods: Patients receiving concurrent DOACs for venous thromboembolism (VTE) or atrial fibrillation and selected targeted anticancer therapies were followed for 6 months after the start of concurrent use. Data including patient and cancer characteristics, major bleeding, non-major bleeding events, and venous or arterial thromboses were collected. Results: Two hundred and two patients were included from six institutions in the United States and Israel. The most common malignancies were hematologic (N = 57, 28.2%), followed by breast (N = 50, 24.8%) and lung (N = 44, 21.8%). The most common anticancer therapies were epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) inhibitors (N = 43, 21.3%), followed by Bruton’s tyrosine kinase (BTK) inhibitors (N = 42, 20.8%) and palbociclib (N = 42, 20.8%). During follow-up, there were 9 major bleeding and 12 non-major bleeding events, corresponding to cumulative incidences of 4% (95% confidence interval [CI]: 2–8%) and 6% (95% CI: 3–10%), respectively. The cumulative incidence of major bleeding events was highest in BTK inhibitor users (10%). There were 3 VTE and 2 arterial thromboses, corresponding to cumulative incidences of 1.5% (95% CI: 0.4–4.0%) and 1.0% (95% CI: 0.2–3.3%), respectively. Conclusions: In this cohort receiving concurrent DOACs and targeted anticancer therapies, the incidence of bleeding is higher compared to thrombosis, particularly with BTK inhibitors. Future larger prospective studies are needed.

Original languageEnglish
Pages (from-to)2068-2081
Number of pages14
JournalJournal of Thrombosis and Haemostasis
Volume19
Issue number8
DOIs
StatePublished - Aug 2021

Funding

FundersFunder number
National Heart, Lung, and Blood InstituteHL143365
International Society on Thrombosis and Haemostasis

    Keywords

    • anticoagulation
    • cancer-associated thrombosis
    • direct oral anticoagulants
    • drug-drug interaction
    • targeted anticancer therapy

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