In a study of adults with advanced prostate cancer taking androgen receptor pathway inhibitors and various types of anticoagulants, researchers found no evidence that the patients were at increased risk of bleeding or clotting, despite previous test results raising alarms. The findings are published on Wiley Online. cancera peer-reviewed journal of the American Cancer Society.
Thromboembolism, caused when a circulating blood clot becomes blocked and causes an occlusion, is the second leading cause of death in cancer patients, surpassed only by progression of the cancer itself. Anticoagulants (blood thinners) are standard therapy for the treatment or prevention of thromboembolism. Thromboembolism is a particular concern for patients with advanced prostate cancer. That’s because laboratory experiments have shown that androgen receptor pathway inhibitors, which are recommended for nearly all patients with advanced prostate cancer, can interact with certain anticoagulants, especially direct oral anticoagulants (DOACs).
To investigate whether these laboratory test results correlated with patients’ actual concerns, researchers evaluated outcomes for patients taking both anticoagulants and androgen receptor pathway inhibitors, such as enzalutamide, apalutamide, and abiraterone.
In a retrospective population-based analysis of 2,997 Canadian adults with prostate cancer who were prescribed anticoagulants (DOAC or non-DOAC) and enzalutamide or apalutamide between 2012 and 2023, researchers found no increased risk of clotting in the DOAC and non-DOAC groups. Similarly, researchers compared a DOAC group with abiraterone to a non-DOAC group and found no increased risk of bleeding.
As clinicians, we are faced daily with the challenge of selecting the best anticoagulant option for our patients, but cancer patients who are taking many other medications, including chemotherapy, add an additional layer of complexity with the potential for drug-drug interactions. Our findings suggest that pharmacokinetic drug interaction concerns may not translate into adverse clinical outcomes in the real world. These results will help clinicians and patients feel more confident when managing anticoagulant therapy alongside modern prostate cancer treatments. ”
Dr. Wang Zufei, Lead author, University of Ottawa Ottawa Hospital and Ottawa Hospital Research Institute
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Reference magazines:
Wang, T. Others. (2026). Risk of thrombosis and bleeding during concurrent use of prostate cancer drugs that may interact with anticoagulants. cancer. DOI: 10.1002/cncr.70266. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.70266
