Trends in Direct Oral Anticoagulant Use for Cancer-Associated Venous Thromboembolism

Importance: Direct oral anticoagulants (DOAC) are recommended for selected patients with cancer-associated venous thromboembolism, but their implementation remains heterogeneous.

Objective

To describe temporal trends in DOAC initiation for cancer-associated venous thromboembolism in France and to identify factors associated with their use. Design, setting, and participants: This nationwide population-based cohort study included adults without recorded contraindications to DOACs and a first treated venous thromboembolism episode between January 1, 2016, and December 31, 2022. Data were collected from the French National Health Data System, a nationwide claims database covering approximately 99% of the population. Analysis was performed from January to August 2025. Exposures: Patients were classified into active cancer and no active cancer groups. Covariates included calendar period, patient characteristics, cancer type and treatment, venous thromboembolism characteristics, and initial prescriber setting. Main outcomes and measures: The primary outcome was DOAC initiation within 30 days after the index venous thromboembolism event. Bayesian structural time series models assessed temporal changes across 2016 to 2018, 2019 to 2020, and 2021 to 2022. Multivariable logistic regression identified factors associated with DOAC initiation among patients with active cancer.