Among patients with lymphoma or plasma cell dyscrasia with venous thromboembolism (VTE), direct oral anticoagulants (DOACs) may be a potential alternative to low molecular weight heparin (LMWH), according to research presented at the Annual Meeting of the Society of Hematologic Oncology (SOHO).

It was previously unclear whether DOACs are a safe and effective treatment option among patients with hematologic malignancies who develop a VTE. The study authors noted there has not, for example, been a controlled trial that specifically investigated clinical outcomes in this patient group only.

For this retrospective cohort study, researchers aimed to evaluate the rate of VTE recurrence and bleeding among patients with lymphoma or plasma cell dyscrasia treated with LMWH or DOACs. All included patients had active disease and a newly diagnosed VTE.

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Overall, data from 143 patients were included, among whom 83 had lymphoma; 96 patients received LMWH while 47 received a DOAC. At baseline, patients who received a DOAC were older, more likely to have a pulmonary embolism, and less likely to have splanchnic vein thrombosis.

Analysis showed that the 12-month cumulative rate of recurrent VTE, clot progression, major bleeding, or clinically relevant non-major bleeding was 24.2% in the LMWH group vs 18.5% in the DOAC group, although this difference was not significantly different (hazard ratio [HR], 1.51; 95% CI, 0.695-3.297).

In the overall cohort, 2 recurrent VTEs were noted, both of which were in the DOAC group, though not during a treatment cycle. The clinically relevant nonmajor bleeding rate was similar between the 2 groups (HR, 1.44; 95% CI, 0.52-3.98).

“This study generates the hypothesis that DOACs may be a safe and effective alternative to LMWH for VTE in patients with lymphoma or plasma cell dyscrasia,” the authors noted. “Larger prospective studies are needed to confirm these findings.”


Robinson R, Spectre G, Lishner M, et al. Direct oral anticoagulants for the treatment of venous thromboembolism in patients with hematological malignancies. Presented at: Annual Meeting of the Society of Hematologic Oncology (SOHO); September 28-October 1, 2022. Abstract ABCL-104.