Although direct oral anticoagulants (DOACs) have been established as an effective option for cancer-associated thrombosis (CAT), there are still concerns about their safety in patients with gastrointestinal (GI) tumours, where they appear to carry a higher risk of bleeding than low-molecular-weight heparin (LMWH). Randomized clinical trials (RCTs) with DOACs in CAT have yielded conflicting results regarding the risk of bleeding in GI cancer. In the HOKUSAI VTE Cancer trial, patients with gastrointestinal cancer had a significantly higher risk of major bleeding when treated with edoxaban compared to dalteparin (HR 4.0, 95 % confidence interval 1.5 to 10.6, p = 0.005).
