Trends in direct oral anticoagulant use for cancer-associated venous thromboembolism in France, 2016-2022

Direct oral anticoagulants (DOAC) are recommended for selected patients with cancer-associated venous thromboembolism (VTE). A nationwide population-based cohort study in France investigated trends in DOAC use between 2016 and 2022. Patients were categorized into active cancer and no active cancer groups. The primary outcome was DOAC initiation within 30 days after the index VTE events. Among 683 184 patients with incident treated VTE during the study period, 91 954 patients (13.5%) had active cancer while 86.5% had VTE not associated with active cancer. Among the patients with active cancer, DOAC initiation increased from 15.3% in 2016-2018 to 32.6% in 2021-2022. Among patients without active cancer, DOAC initiation increased from 63.5% in 2016-2018 to 81.1% in 2021-2022. DOAC use varied by cancer type, cancer treatment, patient characteristics, and prescriber setting (hospital-based versus general practitioner). The authors conclude that DOAC use increased substantially among patients with active cancer but remained lower than among patients without active cancer. This lower uptake may reflect both delayed implementation of recent evidence and the need to individualize anticoagulant selection in complex situations.