Cancer VTE + DOAC: Who Will Bleed? | JACC Baran

Patients with active cancer face a difficult balance: preventing recurrent venous thromboembolism while avoiding major bleeding during anticoagulation. But which patients are truly at highest bleeding risk? Hosts Mitsuaki Sawano, MD welcome Tomoyuki Nagai, MD (Kyoto Prefectural University of Medicine) and Naohiko Nakanishi, MD (Kyoto Prefectural University of Medicine) to discuss their JACC: CardioOncology study introducing the ONCO-DOAC BLEED Score. Using more than 1,100 patients from COMMAND VTE Registry-2 with external validation in two independent cohorts, the investigators identified eight readily available clinical factors that stratify bleeding risk during DOAC therapy in patients with cancer-associated VTE. The conversation explores why existing bleeding scores fall short in patients with active cancer, how cancer type and disease stage influence bleeding risk, the challenges of developing and validating a practical bedside risk score, and what clinicians should consider when balancing thrombosis prevention against bleeding in everyday practice.