Venous thromboembolism (VTE) and stroke carry significant mortality and morbidity in cancer patients. Direct oral anticoagulants (DOACs) have been demonstrated to be effective for the treatment of VTE and prevention of stroke in atrial fibrillation (AF). Bleeding rates are variable and are based on the cancer type and the patient’s specific risk factors. There are approved specific antidotes for DOAC-associated bleeding. Other strategies are available for bleeding reversal, including the use of prothrombin complex concentrate (PCC). No randomized studies have compared head-to-head the efficacy and safety of reversal agents. We aim to examine the safety and effectiveness of hemostatic agents in cancer patients with DOAC-related major bleeding. A retrospective chart review study of patients at MD Anderson Cancer Center with DOAC-related major bleeding between 2014 and 2019. Bleeding severity and clinical hemostasis were described based on ISTH guidelines and the Sarode criteria, respectively. The rates of thrombotic complications and mortality at 30-day from the index bleeding event were described. We identified 23 patients with DOAC-related major bleeding; 14 patients received PCC and 9 patients received andexanet alfa. The most common sites of bleeding were the gastrointestinal tract and intracranial. Effective hemostasis and 30-day mortality were similar to reported results from other reports of outcomes of reversal agents for DOAC related-bleeding in non-cancer patients. One patient in each treatment group experienced a thrombotic event. Further larger scale studies are needed to confirm our findings in cancer patients.

静脉血栓栓塞（VTE）和中风在癌症患者中具有显着的死亡率和发病率。直接口服抗凝剂 (DOAC) 已被证明可有效治疗心房颤动 (AF) 中的静脉血栓栓塞 (VTE) 和预防中风。出血率是可变的，并且取决于癌症类型和患者的具体危险因素。有批准的针对 DOAC 相关出血的特异性解毒剂。其他可用于逆转出血的策略，包括使用凝血酶原复合物浓缩物 (PCC)。尚无随机研究对逆转剂的疗效和安全性进行面对面比较。我们的目的是检查止血剂对患有 DOAC 相关大出血的癌症患者的安全性和有效性。对 MD 安德森癌症中心 2014 年至 2019 年间发生 DOAC 相关大出血的患者进行的回顾性图表回顾研究。分别根据 ISTH 指南和 Sarode 标准描述出血严重程度和临床止血情况。描述了自出血事件起 30 天后的血栓并发症发生率和死亡率。我们确定了 23 名患有 DOAC 相关大出血的患者； 14 名患者接受 PCC，9 名患者接受 andexanet alfa。最常见的出血部位是胃肠道和颅内。有效止血和 30 天死亡率与其他关于非癌症患者 DOAC 相关出血的逆转剂结果报告的结果相似。每个治疗组中都有一名患者经历了血栓事件。需要进一步更大规模的研究来证实我们在癌症患者中的发现。