{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:11:21Z","timestamp":1788883881396,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100006578","name":"Chi Mei Medical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006578","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004844","name":"National Cheng Kung University Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020950","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 113\u20102314\u2010B\u2010110\u2010004\u2010MY3"],"award-info":[{"award-number":["NSTC 113\u20102314\u2010B\u2010110\u2010004\u2010MY3"]}],"id":[{"id":"10.13039\/501100020950","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Direct oral anticoagulants (DOACs) have demonstrated non\u2010inferiority to low\u2010molecular\u2010weight heparin (LMWH) for preventing recurrent venous thromboembolism (VTE) in cancer\u2010associated thrombosis. However, patients with gastrointestinal (GI) cancer receiving DOACs have reported increased major bleeding events. Hereby, we aim to compare the risks of recurrent thromboembolism and bleeding between those treated with DOACs and LMWH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using Taiwan's National Health Insurance Research Database, we retrospectively identified GI cancer patients with newly diagnosed VTE from 2011 to 2020. Outcomes were recurrent VTE and major bleeding. Covariate balancing was performed using inverse probability weighting, and Cox proportional hazards models compared risks, with a competing risk model for death. Follow\u2010up was 12\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1895 patients (1038 on DOACs, 857 on enoxaparin), recurrent VTE occurred in 20.71% of DOAC and 19.25% of enoxaparin patients. Competing risk analysis showed relatively higher recurrent VTE risk with DOACs (subdistribution HR, 1.27; 95% CI, 1.09\u20131.48;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Regarding composite bleeding risk, DOACs were similar compared with LMWH (subdistribution HR, 0.99; 95% CI, 0.68\u20131.45;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.97). However, DOACs presented with an increased GI bleeding risk (subdistribution HR, 2.59; 95% CI, 1.48\u20134.54;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) but a reduced intracranial hemorrhage risk (subdistribution HR, 0.35; 95% CI, 0.16\u20130.78;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with DOACs, LMWH expressed a lower risk of recurrent VTE in GI cancer patients. However, DOAC presented with a lower intracranial hemorrhage risk but a higher GI bleeding risk. Further research is needed to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71838","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T05:40:48Z","timestamp":1776404448000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Direct Oral Anticoagulants Versus Low\u2010Molecular\u2010Weight Heparin for Treating Venous Thromboembolism in Patients With Gastrointestinal Cancer"],"prefix":"10.1002","volume":"15","author":[{"given":"Wei\u2010Ting","family":"Chang","sequence":"first","affiliation":[{"name":"School of Medicine and Doctoral Program of Clinical and Experimental Medicine College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat\u2010sen University  Kaohsiung Taiwan"},{"name":"Department of Cardiology, Chi Mei Medical Center  Tainan Taiwan"},{"name":"School of Medicine College of Medicine, National Sun Yat\u2010sen University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei\u2010Chuan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Chi Mei Medical Center, Hospital, College of Medicine, National Cheng Kung University  Tainan Taiwan"},{"name":"Biostatistics Consulting Center National Cheng Kung University  Tainan Taiwan"},{"name":"Department of Public Health, College of Medicine National Cheng Kung University  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui\u2010Wen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng\u2010Hsiang","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine National Cheng Kung University  Tainan Taiwan"},{"name":"Biostatistics Consulting Center National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University  Tainan Taiwan"},{"name":"Institute of Clinical Medicine, College of Medicine National Cheng Kung University  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3160-1143","authenticated-orcid":false,"given":"Yi\u2010Heng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-022-00336-y"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/1076029620954282"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.00294"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-023-02858-y"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/cas.15106"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1306638"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccao.2022.10.014"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915103"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2018.02.144"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13045-022-01289-1"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccao.2022.08.002"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7501"},{"key":"e_1_2_12_14_1","first-page":"242","article-title":"Cancer\u2010Associated Thrombosis: A Taiwanese Perspective on Therapeutic Options With Focus on Non\u2010Vitamin K Antagonist Oral Anticoagulants","volume":"39","author":"Shao Y. 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