Safety and Efficacy of Low Molecular Weight Heparin Vs. Direct Oral Anticoagulants in Cancer-Associated Venous Thromboembolism

Objective: To compare the safety and efficacy of low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) in treating venous thromboembolism (VTE) among cancer patients. Study Design: Descriptive study. Place and Duration of the Study: Department of General Medicine, Shaukat Khanum Memorial Cancer Hospital, Peshawar, Pakistan, from February to September 2023. Methodology: This retrospective study included 150 cancer patients treated with either LMWH or DOACs for at least one month. The safety and efficacy were measured in terms of occurrences of major bleeding (assessed through International Society of Thrombosis and Haemostasis (ISTH) score) and recurrent VTE within six months. Results: Among the 150 patients studied, 99 (66%) received LMWH, while 51 (34%) were treated with DOACs. The mean age in the LMWH group was 45.49 +/- 13.48 years, compared to 54.00 +/- 12.22 years in the DOAC group. Major bleeding events were more frequent 11 (11.1%) in the LMWH group than 3 (5.9%) in the DOAC group, though this difference was not statistically significant (p = 0.383). Recurrence rates of VTE were higher 8 (16%) in the DOAC group compared to the LMWH group 10 (10.1%), with no statistically significant difference (p = 0.300). The LMWH therapy was associated with a longer median treatment duration (170 days versus 166.5 days for DOACs; p = 0.290) and a statistically significant shorter hospital stay (0-25 days versus 0-30 days for LMWH; p = 0.038). Conclusion: Both DOACs and LMWH are equally effective for managing VTE. DOACs offer relatively shorter treatment durations and hospital stays, though they have a slightly higher recurrence rate and comparable or lower major bleeding risk.