{"@context":"https://schema.org","@type":"ScholarlyArticle","headline":"Risk of intracranial hemorrhage with DOACs vs LMWH in patients with cancer-associated thrombosis and brain metastases.","author":[{"@type":"Person","name":"Ali Mushtaq"},{"@type":"Person","name":"Omer S. Ashruf"},{"@type":"Person","name":"A. Khorana"},{"@type":"Person","name":"Ahmad Safdar"},{"@type":"Person","name":"Sean Hergenrother"},{"@type":"Person","name":"D. Angelini"}],"datePublished":"2025","isPartOf":{"@type":"Periodical","name":"Journal of Clinical Oncology"},"identifier":"https://doi.org/10.1200/jco.2025.43.16_suppl.2034","description":"\n 2034\n \n \n Background:\n Intracranial hemorrhage (ICH) is a major and often devastating complication in patients with brain metastases requiring therapeutic anticoagulation for cancer-associated thromboembolism (CAT). While direct oral anticoagulants (DOACs) provide a convenient alternative to low-molecular-weight heparin (LMWH), their safety in this population remains unclear. Comparing ICH risk between DOACs and LMWH is crucial for optimizing anticoagulation in these high-risk patients.\n Methods:\n This retrospective cohort study utilized TriNetX, a multi-institutional database, to analyze adults with solid tumors who developed CAT within six months of brain metastasis diagnosis. Patients receiving therapeutic-dose DOACs (apixaban, rivaroxaban, edoxaban) or LMWH within ten days of venous thromboembolism diagnosis were compared. 1:1 propensity score matching for over 50 covariates, including age, sex, and cancer type (Table 1). We assessed ICH incidence, bleeding events, ICU admissions, and all-cause mortality using Kaplan-Meier survival analysis and Cox proportional hazards models. Subgroup analyses examined ICH risk by cancer type.\n Results:\n After matching, 4,275 patients were included in each group. DOACs were associated with a statistically significant lower risk of ICH (HR 0.855, 95% CI 0.731-0.999, p=0.049). Additionally, significantly lower rates of ICU admission (16.7% vs. 20.3%; p<0.001) and all-cause mortality at 12 months (42.4% vs. 48.9%; p<0.001) were observed in the DOAC group. Subgroup analyses showed a trend toward lower ICH with DOACs in lung cancer (5.9% vs. 6.1%, p=0.726), melanoma (13.7% vs. 15.9%, p=0.432), and renal cell carcinoma (5.7% vs. 9.0%, p=0.103), but these differences were not statistically significant. No significant differences were found for breast (3.6% vs. 4.5%, p=0.375) or colorectal cancer (4.0% vs. 5.4%, p=0.331).\n Conclusions:\n DOACs were associated with significantly lower ICH, ICU admission, and mortality compared to LMWH in patients with brain metastases requiring anticoagulation, supporting their role as a viable and well-tolerated alternative. While subgroup analyses did not show significant differences in ICH risk by cancer type, the overall findings indicate a favorable profile for DOACs. These results highlight the need for individualized anticoagulation strategies and warrant further prospective validation.\n \n \n Baseline characteristics after matching.\n \n \n \n \n Characteristic\n DOAC (n=4275)\n LMWH (n=4275)\n \n \n \n \n Age (years), mean ± SD\n 63.4 ± 11.9\n 63.5 ± 11.9\n \n \n Female, n (%)\n 1969 (46.1%)\n 1958 (45.8%)\n \n \n Lung Cancer, n (%)\n 2218 (51.9%)\n 2229 (52.1%)\n \n \n Breast Cancer, n (%)\n 692 (16.2%)\n 672 (15.7%)\n \n \n Melanoma, n (%)\n 280 (6.5%)\n 279 (6.5%)\n \n \n Renal Cell, n (%)\n 241 (5.6%)\n 244 (5.7%)\n \n \n Colorectal, n (%)\n 408 (9.5%)\n 413 (9.6%)\n \n \n \n \n ","url":"https://innscience.ca/en/community/literature/5eaeaf13-6d38-475f-aa20-f8588c90a9e7"}