{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T16:39:09Z","timestamp":1792773549795,"version":"4.5.0"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Direct oral anticoagulants (DOAC) are recommended for selected patients with cancer-associated venous thromboembolism, but their implementation remains heterogeneous.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To describe temporal trends in DOAC initiation for cancer-associated venous thromboembolism in France and to identify factors associated with their use.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 683\u202f184 patients with incident treated venous thromboembolism (median [IQR] age, 67 [53-77] years; 347\u202f421 female [51.0%]), 91\u202f954 patients (13.5%) had active cancer while 591\u202f230 (86.5%) had VTE not associated with active cancer. DOAC use increased from 15.3% (95% CI, 15.0%-15.7%) in 2016 to 2018 to 32.6% (95% CI, 32.1%-33.2%) in 2021 to 2022 among patients with active cancer, and from 63.5% (95% CI, 63.3%-63.7%) to 81.1% (95% CI, 80.9%-81.2%) among patients without active cancer. DOAC initiation increased beyond expected secular trends in patients with active cancer, with relative increases of 20.5% (95% credible interval, 13.0%-27.8%) in 2019 to 2020 and 41.3% (95% credible interval, 32.9%-50.2%) in 2021 to 2022. DOAC initiation was less frequent among patients with comorbidities, history of bleeding, gastrointestinal or gynecologic cancer, active brain metastases, or systemic treatment, and when the initial prescriber was a hospital-based physician rather than a general practitioner.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of patients with incident venous thromboembolism, DOAC use increased substantially in patients with active cancer but remained lower than in patients without active cancer and varied across clinical and care-setting characteristics. This lower uptake may reflect both delayed implementation of recent evidence and the need to individualize anticoagulant selection in complex situations.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.40377","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T15:30:25Z","timestamp":1792769425000},"page":"e2640377","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Direct Oral Anticoagulant Use for Cancer-Associated Venous Thromboembolism"],"prefix":"10.1001","volume":"9","author":[{"given":"Romain","family":"Varnier","sequence":"first","affiliation":[{"name":"Research on Healthcare Performance, INSERM U1290, Universit\u00e9 Claude Bernard Lyon 1, Lyon, France"},{"name":"Department of Medical Oncology, Centre L\u00e9on B\u00e9rard, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Bettega","sequence":"additional","affiliation":[{"name":"Research on Healthcare Performance, INSERM U1290, Universit\u00e9 Claude Bernard Lyon 1, Lyon, France"},{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, INSA Lyon, CNRS, MATEIS, UMR5510, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Moskal","sequence":"additional","affiliation":[{"name":"Research on Healthcare Performance, INSERM U1290, Universit\u00e9 Claude Bernard Lyon 1, Lyon, France"},{"name":"Health Data Department, Hospices Civils de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Mainbourg","sequence":"additional","affiliation":[{"name":"Clinical and Epidemiological Databases Unit, Hospices Civils de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myl\u00e8ne","family":"Wespiser","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Centre L\u00e9on B\u00e9rard, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Rousseau","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, Gustave Roussy, Department of Cancer Medicine, Thoracic Group and International Center for Thoracic Cancers, Villejuif, France"},{"name":"Inserm, Oncostat U1018, Labeled Ligue Contre le Cancer, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Viprey","sequence":"additional","affiliation":[{"name":"Research on Healthcare Performance, INSERM U1290, Universit\u00e9 Claude Bernard Lyon 1, Lyon, France"},{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, INSA Lyon, CNRS, MATEIS, UMR5510, Lyon, France"},{"name":"Health Data Department, Hospices Civils de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"issue":"2","key":"zoi261096r1","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1634\/theoncologist.2016-0214","article-title":"Cancer and venous thromboembolic disease: a review.","volume":"22","author":"Donnellan","year":"2017","journal-title":"Oncologist"},{"issue":"14","key":"zoi261096r2","doi-asserted-by":"publisher","first-page":"1959","DOI":"10.1182\/blood.2020007338","article-title":"Venous thromboembolism in cancer patients: a population-based cohort study.","volume":"137","author":"Mulder","year":"2021","journal-title":"Blood"},{"issue":"3","key":"zoi261096r3","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1111\/j.1538-7836.2007.02374.x","article-title":"Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy.","volume":"5","author":"Khorana","year":"2007","journal-title":"J Thromb Haemost"},{"issue":"6","key":"zoi261096r4","doi-asserted-by":"publisher","first-page":"454S","DOI":"10.1378\/chest.08-0658","article-title":"Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians evidence-based clinical practice guidelines.","volume":"133","author":"Kearon","year":"2008","journal-title":"Chest"},{"issue":"6","key":"zoi261096r5","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1200\/JCO.2014.59.7351","article-title":"Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update 2014.","volume":"33","author":"Lyman","year":"2015","journal-title":"J Clin Oncol"},{"issue":"9","key":"zoi261096r6","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1056\/NEJMoa1302507","article-title":"Oral apixaban for the treatment of acute venous thromboembolism.","volume":"369","author":"Agnelli","year":"2013","journal-title":"N Engl J Med"},{"issue":"26","key":"zoi261096r7","doi-asserted-by":"publisher","first-page":"2499","DOI":"10.1056\/NEJMoa1007903","article-title":"Oral rivaroxaban for symptomatic venous thromboembolism.","volume":"363","author":"Bauersachs","year":"2010","journal-title":"N Engl J Med"},{"issue":"24","key":"zoi261096r8","doi-asserted-by":"publisher","first-page":"2342","DOI":"10.1056\/NEJMoa0906598","article-title":"Dabigatran versus warfarin in the treatment of acute venous thromboembolism.","volume":"361","author":"Schulman","year":"2009","journal-title":"N Engl J Med"},{"issue":"22","key":"zoi261096r9","doi-asserted-by":"publisher","first-page":"1924","DOI":"10.1001\/jama.2023.7843","article-title":"Direct oral anticoagulants vs low-molecular-weight heparin and recurrent VTE in patients with cancer: a randomized clinical trial.","volume":"329","author":"Schrag","year":"2023","journal-title":"JAMA"},{"issue":"7","key":"zoi261096r10","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1056\/NEJMoa1711948","article-title":"Edoxaban for the treatment of cancer-associated venous thromboembolism.","volume":"378","author":"Raskob","year":"2018","journal-title":"N Engl J Med"},{"issue":"20","key":"zoi261096r11","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1200\/JCO.2018.78.8034","article-title":"Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D).","volume":"36","author":"Young","year":"2018","journal-title":"J Clin Oncol"},{"issue":"17","key":"zoi261096r12","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1056\/NEJMoa1915103","article-title":"Apixaban for the treatment of venous thromboembolism associated with cancer.","volume":"382","author":"Agnelli","year":"2020","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi261096r13","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1016\/j.chest.2021.09.037","article-title":"Rivaroxaban vs dalteparin in cancer-associated thromboembolism: a randomized trial.","volume":"161","author":"Planquette","year":"2022","journal-title":"Chest"},{"issue":"5","key":"zoi261096r14","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1055\/s-0041-1735194","article-title":"Apixaban and dalteparin for the treatment of venous thromboembolism in patients with different sites of cancer.","volume":"122","author":"Agnelli","year":"2022","journal-title":"Thromb Haemost"},{"issue":"2","key":"zoi261096r15","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1111\/jth.14662","article-title":"Apixaban and dalteparin in active malignancy-associated venous thromboembolism: the ADAM VTE trial.","volume":"18","author":"McBane","year":"2020","journal-title":"J Thromb Haemost"},{"issue":"10","key":"zoi261096r16","doi-asserted-by":"publisher","first-page":"e566","DOI":"10.1016\/S1470-2045(19)30336-5","article-title":"2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer.","volume":"20","author":"Farge","year":"2019","journal-title":"Lancet Oncol"},{"issue":"5","key":"zoi261096r17","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1200\/JCO.19.01461","article-title":"Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update.","volume":"38","author":"Key","year":"2020","journal-title":"J Clin Oncol"},{"issue":"2","key":"zoi261096r18","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.rmr.2019.01.003","article-title":"Recommandations de bonne pratique pour la prise en charge de la maladie veineuse thromboembolique chez l\u2019adulte. Version courte.","volume":"36","author":"Sanchez","year":"2019","journal-title":"Rev Mal Respir"},{"issue":"6","key":"zoi261096r20","doi-asserted-by":"publisher","first-page":"e545","DOI":"10.1016\/j.chest.2021.07.055","article-title":"Antithrombotic therapy for VTE disease: second update of the CHEST Guideline and Expert Panel report.","volume":"160","author":"Stevens","year":"2021","journal-title":"Chest"},{"issue":"4","key":"zoi261096r22","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.rmr.2021.03.001","article-title":"Traitement de la maladie veineuse thromboembolique au cours du cancer. Mise \u00e0 jour mars 2021.","volume":"38","author":"Mah\u00e9","year":"2021","journal-title":"Rev Mal Respir"},{"issue":"9391","key":"zoi261096r23","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1016\/S0140-6736(03)14546-1","article-title":"From best evidence to best practice: effective implementation of change in patients\u2019 care.","volume":"362","author":"Grol","year":"2003","journal-title":"Lancet"},{"issue":"17","key":"zoi261096r24","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3390\/cancers14174143","article-title":"Management of cancer-associated thrombosis in France: a national survey among vascular disease and supportive care specialists.","volume":"14","author":"Mah\u00e9","year":"2022","journal-title":"Cancers (Basel)"},{"key":"zoi261096r25","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.ygyno.2023.04.012","article-title":"Direct oral anticoagulant (DOACs) prescribing practices of members of the Society of Gynecologic Oncology and American Society of Clinical Oncology.","volume":"173","author":"Scanlon","year":"2023","journal-title":"Gynecol Oncol"},{"key":"zoi261096r26","doi-asserted-by":"publisher","DOI":"10.1177\/1076029620975489","article-title":"Retrospective review of prescribing patterns in cancer-associated thrombosis: a single center experience in Edmonton, Alberta, Canada.","author":"Kaliel","year":"2021","journal-title":"Clin Appl Thromb Hemost"},{"key":"zoi261096r27","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.thromres.2020.09.008","article-title":"Temporal trends in first-line outpatient anticoagulation treatment for cancer-associated venous thromboembolism.","volume":"196","author":"Delate","year":"2020","journal-title":"Thromb Res"},{"issue":"7624","key":"zoi261096r28","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"335","author":"von Elm","year":"2007","journal-title":"BMJ"},{"key":"zoi261096r29","doi-asserted-by":"publisher","first-page":"S149","DOI":"10.1016\/j.respe.2017.05.004","article-title":"Value of a national administrative database to guide public decisions: From the syst\u00e8me national d\u2019information interr\u00e9gimes de l\u2019Assurance Maladie (SNIIRAM) to the syst\u00e8me national des donn\u00e9es de sant\u00e9 (SNDS) in France.","volume":"65","author":"Tuppin","year":"2017","journal-title":"Rev Epidemiol Sante Publique"},{"issue":"4","key":"zoi261096r30","doi-asserted-by":"publisher","DOI":"10.1002\/pds.5781","article-title":"Design and validation of algorithms to identify venous thromboembolism in the French National Healthcare Database.","volume":"33","author":"Thurin","year":"2024","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"9","key":"zoi261096r31","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1097\/MLR.0000000000001745","article-title":"The economic burden of disease in France from the national health insurance perspective: the healthcare expenditures and conditions mapping used to prepare the French Social Security Funding Act and the Public Health Act.","volume":"60","author":"Rachas","year":"2022","journal-title":"Med Care"},{"issue":"9","key":"zoi261096r32","doi-asserted-by":"publisher","first-page":"1891","DOI":"10.1111\/jth.14219","article-title":"Role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism: guidance from the SSC of the ISTH.","volume":"16","author":"Khorana","year":"2018","journal-title":"J Thromb Haemost"},{"issue":"1","key":"zoi261096r33","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/1471-2458-9-33","article-title":"Ecological association between a deprivation index and mortality in France over the period 1997 to 2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death.","volume":"9","author":"Rey","year":"2009","journal-title":"BMC Public Health"},{"issue":"2","key":"zoi261096r34","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1097\/MLR.0000000000000471","article-title":"The best use of the Charlson Comorbidity Index with electronic health care database to predict mortality.","volume":"54","author":"Bannay","year":"2016","journal-title":"Med Care"},{"issue":"1","key":"zoi261096r35","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1214\/14-AOAS788","article-title":"Inferring causal impact using bayesian structural time-series models.","volume":"9","author":"Brodersen","year":"2015","journal-title":"Ann Appl Stat"},{"key":"zoi261096r36","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12959-016-0078-0","article-title":"Incidence of venous thromboembolism in France: a retrospective analysis of a national insurance claims database.","volume":"14","author":"Bou\u00e9e","year":"2016","journal-title":"Thromb J"},{"issue":"3","key":"zoi261096r37","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1016\/j.chest.2020.11.005","article-title":"Incidence of VTE and bleeding among hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis.","volume":"159","author":"Jim\u00e9nez","year":"2021","journal-title":"Chest"},{"issue":"4","key":"zoi261096r38","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1007\/s11239-023-02943-2","article-title":"A ten-year comparison of treatment and outcomes of cancer-associated thrombosis to non-cancer venous thromboembolism: from traditional anticoagulants to direct oral anticoagulants.","volume":"57","author":"Wee","year":"2024","journal-title":"J Thromb Thrombolysis"},{"issue":"1","key":"zoi261096r39","doi-asserted-by":"publisher","first-page":"e61","DOI":"10.1055\/a-2214-8101","article-title":"Treatment patterns of cancer-associated thrombosis in the Netherlands: the Four Cities Study.","volume":"8","author":"Kaptein","year":"2024","journal-title":"TH Open"},{"issue":"6","key":"zoi261096r40","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1016\/j.jaccao.2023.09.003","article-title":"Cancer-associated thrombosis: trends in clinical features, treatment, and outcomes From 2001 to 2020.","volume":"5","author":"Bertoletti","year":"2023","journal-title":"JACC CardioOncol"},{"issue":"3","key":"zoi261096r41","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.4059","article-title":"Trends in the use of oral anticoagulants for adults with venous thromboembolism in the US, 2010-2020.","volume":"6","author":"Iyer","year":"2023","journal-title":"JAMA Netw Open"},{"key":"zoi261096r42","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.991376","article-title":"Predictors of use of direct oral anticoagulants in patients with venous thromboembolism: findings from the Registro Informatizado Enfermedad Tromboemb\u00f3lica Registry.","volume":"9","author":"Lorenzo","year":"2022","journal-title":"Front Med (Lausanne)"},{"issue":"2","key":"zoi261096r43","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1007\/s11239-019-02032-3","article-title":"Inpatient and outpatient treatment patterns of cancer-associated thrombosis in the United States.","volume":"50","author":"Guo","year":"2020","journal-title":"J Thromb Thrombolysis"},{"key":"zoi261096r44","doi-asserted-by":"publisher","DOI":"10.1177\/1076029620979575","article-title":"Treatment patterns and clinical outcomes in Korean cancer patients with venous thromboembolism: a retrospective cohort study.","author":"Bang","journal-title":"Clin Appl Thromb Hemost"},{"issue":"9","key":"zoi261096r45","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1002\/cncr.35220","article-title":"Practical guidance for direct oral anticoagulant use in the treatment of venous thromboembolism in primary and metastatic brain tumor patients.","volume":"130","author":"Ranjan","year":"2024","journal-title":"Cancer"},{"issue":"4","key":"zoi261096r46","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1159\/000521698","article-title":"Anticoagulation practice in patients with cancer-associated thrombosis: insights from GeCAT, a German prospective registry study.","volume":"45","author":"Klamroth","year":"2022","journal-title":"Oncol Res Treat"},{"issue":"11","key":"zoi261096r47","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1007\/s40262-023-01298-4","article-title":"Anti-coagulant treatment of cancer-associated thrombosis in frail patients: impact of frailties on the management of drug-drug interactions.","volume":"62","author":"Grange","year":"2023","journal-title":"Clin Pharmacokinet"},{"key":"zoi261096r19","author":"Association Francophone des Soins Oncologiques de Support","year":"2019"},{"key":"zoi261096r21","unstructured":"Association Francophone des Soins Oncologiques de Support. Prise en charge de la maladie thromboembolique veineuse en canc\u00e9rologie. Published July 7, 2021. Accessed September 17, 2026. https:\/\/www.afsos.org\/fiche-referentiel\/prise-charge-de-maladie-thromboembolique-veineuse-cancerologie\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2855776\/varnier_2026_oi_261096_1792177273.83223.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T15:30:26Z","timestamp":1792769426000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2855776"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,23]]},"references-count":47,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.40377","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,23]]}}}