Concurrent anti-VEGF and anticoagulant use in cancer patients with VTE shows rare bleeding events

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Frontiers in Medicine Published April 24, 2026 Medically reviewed April 24, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Note that bleeding risk remains poorly characterized in cancer patients receiving concurrent anti-VEGF and anticoagulant therapy.

This retrospective analysis combined with pharmacovigilance assessment evaluated 208 patients at Hunan Cancer Hospital who received concurrent anti-VEGF agents and anticoagulants for venous thromboembolism (VTE) between 1 January 2010 and 1 October 2025. The study population included patients using TKIs or Bev with anticoagulants.

The proportion of TKI users receiving anticoagulants was 32.53%, and the proportion of Bev users receiving anticoagulants was 41.6%. Among patients administered prophylactic anticoagulants in VTE treatment groups, 51.85% used TKIs and 61.54% used Bev. Median co-administration durations were 4 days for TKIs in the prophylaxis group, 30 days for TKIs in the treatment group, 28.5 days for Bev in the prophylaxis group, and 50 days for Bev in the treatment group.

Bleeding events were reported as rare across all groups. Safety data indicated bleeding events as the primary adverse event, but serious adverse events, discontinuations, and tolerability were not reported.

Key limitations include that bleeding risk remains poorly characterized. The study's retrospective design and lack of a comparator group limit causal inference. Practice relevance was not reported, and findings should be considered hypothesis-generating rather than definitive for clinical decision-making.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundThe concurrent use of anti-vascular endothelial growth factor (VEGF) agents and anticoagulants has become increasingly unavoidable in oncology, while the associated bleeding risk remains poorly characterized.MethodsA retrospective analysis combined with pharmacovigilance assessment was conducted to assess the associated bleeding risk. Patients who received concurrent use of anti-VEGF agents and anticoagulants at Hunan Cancer Hospital between 1 January 2010, and 1 October 2025, were included. Data on demographics, safety and duration of co-administration were collected. Additionally, drug-drug interaction signals were analyzed using FDA Adverse Event Reporting System (FAERS) (Q1, 2013 - Q4, 2024) via Ω shrinkage measure.ResultsAmong 208 patients (83 on TKIs, 125 on Bev), 32.53% of TKI users and 41.6% of Bev users received anticoagulants for VTE treatment. In the TKI/Bev VTE treatment groups, 51.85% and 61.54% of patients were administered prophylactic anticoagulants, respectively. Rivaroxaban was the primary anticoagulant, followed by low molecular weight heparin (LMWH). For TKIs, the median co-administration duration was 4 days in the prophylaxis group and 30 days in the treatment group, whereas for Bev, the corresponding duration was 28.5 days and 50 days, respectively. Bleeding events were rare across all groups (