{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:03:00Z","timestamp":1787022180925,"version":"build-2736575974"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Cancer Center Research and Development Fund","award":["2023-A-12"],"award-info":[{"award-number":["2023-A-12"]}]},{"name":"MHLW Research for Promotion of Cancer Control Programs","award":["23EA1036"],"award-info":[{"award-number":["23EA1036"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The introduction of direct oral anticoagulants (DOACs) for venous thromboembolism (VTE) treatment has led to their widespread adoption in clinical practice, potentially influencing management strategies and patient outcomes. However, real-world data on cancer-associated VTE in the DOAC era remain limited. This study aimed to evaluate the clinical characteristics and long-term outcomes of patients with cancer- and non-cancer-associated VTE in a real-world setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed patients diagnosed with deep vein thrombosis (DVT) using lower-extremity venous ultrasound between January 2015 and August 2020 at the University of Tsukuba Hospital, a tertiary academic referral center in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 2,281 patients with DVT, comprising 1,152 with active cancer (cancer group) and 1,129 without cancer (non-cancer group). The cumulative 5-year incidence of recurrent VTE was significantly higher in the cancer group than in the non-cancer group (25% vs. 10%, P\u2009&lt;\u20090.001). After adjusting for confounders and accounting for the competing risk of mortality, cancer remained a significant risk factor for recurrence (adjusted subdistribution hazard ratio [sHR]: 2.00; 95% confidence interval [CI]: 1.46\u20132.74). Similarly, the cumulative 5-year incidence of major bleeding was significantly higher in the cancer group (30% vs. 9.6%, P\u2009&lt;\u20090.001). After adjustment, the risk of major bleeding remained significantly elevated in the cancer group compared to that in the non-cancer group (adjusted sHR: 2.69; 95% CI: 1.90\u20133.81). In the cancer group, discontinuation of bleeding-related anticoagulation therapy was associated with increased VTE recurrence (P\u2009&lt;\u20090.001), whereas no such association was observed in the non-cancer group (P\u2009=\u20090.716).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the DOAC era, similar to the warfarin era, patients with cancer exhibited significantly higher rates of VTE recurrence and major bleeding than those without cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0329025","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T17:24:04Z","timestamp":1753809844000},"page":"e0329025","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk of recurrence and bleeding in patients with cancer-associated venous thromboembolism in the direct oral anticoagulants era: Findings from the TULIPE registry"],"prefix":"10.1371","volume":"20","author":[{"given":"Yuki","family":"Ishizuka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9759-1008","authenticated-orcid":true,"given":"Kazuko","family":"Tajiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Naito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momoko","family":"Murata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Hattori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1901-7112","authenticated-orcid":true,"given":"Tomoko","family":"Machino-Ohtsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3794-899X","authenticated-orcid":true,"given":"Tomoko","family":"Ishizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"issue":"10","key":"pone.0329025.ref001","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1182\/blood-2013-04-460121","article-title":"Epidemiology 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