PO011 | A TWO CENTERS REAL-WORLD EXPERIENCE WITH ANTI-XA DIRECT ORAL ANTICOAGULANTS IN CANCER PATIENTS WITH UNUSUAL SITE VEIN THROMBOSIS
Abstract
Background and aims. Unusual-site venous thrombosis (USVT) refers to the occurrence of venous thromboembolism (VTE) in atypical sites, such as the upper extremities, splanchnic (portal, mesenteric, hepatic, splenic, gonadal, renal) and cerebral veins. Cancer is one of the most frequent predisposing conditions for USVT. However, evidence supporting the use of direct oral anticoagulants (DOACs) in these settings remains limited, as pivotal clinical trials on DOACs typically excluded patients with USVT. We aimed to evaluate the safety and efficacy of DOACs in active cancer patients affected by USVT referred to our two centers for congenital bleeding and thrombotic disorders. Methods. We evaluated 28 consecutive patients with active malignancy and USVT (16 females and 12 males, median age 62.3 years) referred to our centers between January 2023 and January 2026. Thrombosis sites included: 8 (28.6%) splenoportal axis, 4 (14.3%) inferior vena cava, 1 (3.6%) renal vein, 1 (3.6%) ovarian vein, and 14 (50%) upper limb venous thrombosis. Nine patients (32.1%) had onco-hematological diseases (Multiple Myeloma, Non-Hodgkin Lymphoma, Hodgkin Lymphoma) and 19 (67.9%) had solid tumors. All patients received initial parenteral anticoagulation for at least 15 days before transitioning to a DOAC (Apixaban 64.3%, Rivaroxaban 7.1%, or Edoxaban 28.6%) at full or reduced doses according to label criteria. Results. Over a median follow-up of 7 months, follow-up imaging was performed at 3 and 6 months. No major bleeding occurred. One patient (Non-Hodgkin Lymphoma) experienced an ISTH clinically relevant non-major bleeding (CRNMB), manifesting as mild anemia during chemotherapy; DOAC was switched to prophylactic low-molecular-weight heparin after 5 months of full-dose treatment. Two patients discontinued anticoagulation due to cancer remission. Regarding radiological outcomes, 15 patients showed persistent thrombosis, while 13 initially achieved complete recanalization. Among the latter, 2 patients subsequently experienced an ipsilateral thrombotic recurrence during treatment (one of which was associated with the initiation of Lenalidomide), while the remaining 11 maintained complete recanalization. Anticoagulation was continued in all patients with persistent or recurrent disease due to active malignancy. Finally, seven patients died due to cancer progression (3 from the recanalization group and 4 from the persistent thrombosis group). Conclusions. Our real-world data suggest that DOACs are a viable and safe therapeutic option for patients with active malignancy and venous thrombosis at atypical sites (USVT). In our cohort, both recurrent thrombotic events and bleeding complications appear to be clinically acceptable, supporting the use of these agents in a complex oncological setting. However, the high prevalence of persistent thrombosis observed during follow-up confirms that active cancer remains a significant risk factor for impaired radiological recanalization. These findings highlight the necessity of personalized anticoagulant strategies and rigorous monitoring, tailored to the patient’s specific oncological profile, treatment burden, and evolving clinical status.
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BibTeX
@article{guida2026po011,
title = {{PO011 | A TWO CENTERS REAL-WORLD EXPERIENCE WITH ANTI-XA DIRECT ORAL ANTICOAGULANTS IN CANCER PATIENTS WITH UNUSUAL SITE VEIN THROMBOSIS}},
author = {Anna Guida},
journal = {Bleeding, Thrombosis and Vascular Biology},
year = {2026},
month = oct,
url = {https://www.btvb.org/btvb/article/view/827},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - PO011 | A TWO CENTERS REAL-WORLD EXPERIENCE WITH ANTI-XA DIRECT ORAL ANTICOAGULANTS IN CANCER PATIENTS WITH UNUSUAL SITE VEIN THROMBOSIS
AU - Anna Guida
PY - 2026
DA - 2026/10/26
JO - Bleeding, Thrombosis and Vascular Biology
UR - https://www.btvb.org/btvb/article/view/827
AB - Background and aims. Unusual-site venous thrombosis (USVT) refers to the occurrence of venous thromboembolism (VTE) in atypical sites, such as the upper extremities, splanchnic (portal, mesenteric, hepatic, splenic, gonadal, renal) and cerebral veins. Cancer is one of the most frequent predisposing conditions for USVT. However, evidence supporting the use of direct oral anticoagulants (DOACs) in these settings remains limited, as pivotal clinical trials on DOACs typically excluded patients with USVT. We aimed to evaluate the safety and efficacy of DOACs in active cancer patients affected by USVT referred to our two centers for congenital bleeding and thrombotic disorders. Methods. We evaluated 28 consecutive patients with active malignancy and USVT (16 females and 12 males, median age 62.3 years) referred to our centers between January 2023 and January 2026. Thrombosis sites included: 8 (28.6%) splenoportal axis, 4 (14.3%) inferior vena cava, 1 (3.6%) renal vein, 1 (3.6%) ovarian vein, and 14 (50%) upper limb venous thrombosis. Nine patients (32.1%) had onco-hematological diseases (Multiple Myeloma, Non-Hodgkin Lymphoma, Hodgkin Lymphoma) and 19 (67.9%) had solid tumors. All patients received initial parenteral anticoagulation for at least 15 days before transitioning to a DOAC (Apixaban 64.3%, Rivaroxaban 7.1%, or Edoxaban 28.6%) at full or reduced doses according to label criteria. Results. Over a median follow-up of 7 months, follow-up imaging was performed at 3 and 6 months. No major bleeding occurred. One patient (Non-Hodgkin Lymphoma) experienced an ISTH clinically relevant non-major bleeding (CRNMB), manifesting as mild anemia during chemotherapy; DOAC was switched to prophylactic low-molecular-weight heparin after 5 months of full-dose treatment. Two patients discontinued anticoagulation due to cancer remission. Regarding radiological outcomes, 15 patients showed persistent thrombosis, while 13 initially achieved complete recanalization. Among the latter, 2 patients subsequently experienced an ipsilateral thrombotic recurrence during treatment (one of which was associated with the initiation of Lenalidomide), while the remaining 11 maintained complete recanalization. Anticoagulation was continued in all patients with persistent or recurrent disease due to active malignancy. Finally, seven patients died due to cancer progression (3 from the recanalization group and 4 from the persistent thrombosis group). Conclusions. Our real-world data suggest that DOACs are a viable and safe therapeutic option for patients with active malignancy and venous thrombosis at atypical sites (USVT). In our cohort, both recurrent thrombotic events and bleeding complications appear to be clinically acceptable, supporting the use of these agents in a complex oncological setting. However, the high prevalence of persistent thrombosis observed during follow-up confirms that active cancer remains a significant risk factor for impaired radiological recanalization. These findings highlight the necessity of personalized anticoagulant strategies and rigorous monitoring, tailored to the patient’s specific oncological profile, treatment burden, and evolving clinical status.
SN - 2785-5309
ER -