Related Experiment Video
Updated: Jun 18, 2026
04:40
Venous Thrombosis Assay in a Mouse Model of Cancer
Published on: January 5, 2024
A Bleeding Risk Score for Cancer-Associated Venous Thromboembolism in Patients Receiving Direct Oral Anticoagulants
Tomoyuki Nagai1, Naohiko Nakanishi1, Yugo Yamashita2
1Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
JACC. Cardiooncology
|June 17, 2026
Summary
A new ONCO-DOAC BLEED score helps assess major bleeding risk in cancer patients with venous thromboembolism (VTE) on direct oral anticoagulants (DOACs). This tool aids in personalized treatment decisions for this high-risk group.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Cancer patients with venous thromboembolism (VTE) face high bleeding risks during anticoagulant therapy.
- Direct oral anticoagulants (DOACs) are increasingly used, necessitating accurate bleeding risk assessment.
- Existing bleeding risk scores are often not validated for cancer-associated VTE patients on DOACs.
Purpose of the Study:
- To develop and validate a novel bleeding risk score, the ONCO-DOAC BLEED score.
- To identify key risk factors for major bleeding in cancer-associated VTE patients treated with DOACs.
- To improve risk stratification for major bleeding in this specific patient population.
Main Methods:
- The ONCO-DOAC BLEED score was derived from 1,166 patients in the COMMAND VTE Registry-2.
- External validation was performed using an independent cohort from the ONCO deep vein thrombosis and ONCO pulmonary embolism studies.
- Multivariable analysis identified independent predictors of major bleeding.
Main Results:
- Major bleeding occurred in 10.9% of patients over a median follow-up of 163 days.
- Independent predictors of major bleeding included prior major bleeding, chronic kidney disease, NSAID use, and advanced/specific cancer types.
- The ONCO-DOAC BLEED score showed moderate discrimination (C-indices 0.62-0.68) and comparable performance to existing scores.
Conclusions:
- The ONCO-DOAC BLEED score effectively stratifies major bleeding risk in cancer-associated VTE patients on DOAC therapy.
- This score can support individualized therapeutic decision-making in clinical practice.
- The score's validation in independent cohorts supports its utility.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:30Venous Thrombosis IV: Nursing Management
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:24Disorders of Hemostasis
Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:30Venous Thrombosis I: Introduction
Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...