Precautions during Direct Oral Anticoagulant Introduction in Gynecologic Malignancies: A Single-Center Retrospective Cohort Study

SIMPLE SUMMARY: This study aimed to elucidate the risk factors for venous thromboembolism (VTE) recurrence/exacerbation or a change from a direct oral anticoagulant (DOAC) to another anticoagulant in patients with gynecologic cancer using DOACs. Our investigation reveals that ovarian clear cell carcinoma, pulmonary embolism (PE) or proximal deep vein thrombosis without PE, and elevated D-dimer levels at VTE diagnosis are associated with increased odds of a primary outcome in this population. The findings of this study will provide clinicians with a scientific basis to facilitate the identification of high-risk patients and ensure prompt treatment and careful follow-up after DOAC initiation for the early recognition of treatment failure. ABSTRACT: The risk factors for venous thromboembolism (VTE) recurrence/exacerbation or a change from a direct oral anticoagulant (DOAC) to another anticoagulant in patients with gynecologic cancer using DOACs have not been thoroughly elucidated. Here, we aimed to investigate the risk factors for a composite primary outcome, including VTE recurrence/exacerbation, or a change from a DOAC to another anticoagulant, in this population. A total of 63 patients were analyzed. Risk factors for a primary outcome within 2 years after DOAC initiation were investigated using multiple logistic regression analysis. Among the 63 patients, 10 developed a primary outcome. Clear cell carcinoma of the ovary (adjusted odds ratio (aOR), 18.9; 95% confidence interval (CI), 2.25–350.74), pulmonary embolism (PE) or proximal deep vein thrombosis without PE (aOR, 55.6; 95% CI, 3.29–11,774.66), and D-dimer levels in the third tertile (≥7.6 μg/dL) when VTE was first diagnosed (aOR, 6.37; 95% CI, 1.17–66.61) were associated with increased odds of a primary outcome in patients with gynecologic cancer using DOACs. Patients with one or more risk factors for a primary outcome require careful follow-up after DOAC initiation for the early recognition of treatment failure.