Background/Aim: There is almost no study on direct oral anticoagulant (DOAC) for the treatment of venous thromboembolism (VTE) in Japanese patients with advanced cancer. The aim of this study was to evaluate the efficacy of DOAC for the treatment of VTE in Japanese patients with advanced cancer. Methods: We retrospectively reviewed patients with active cancer who had new-onset proximal deep vein thrombosis and/or pulmonary embolism at our hospital. We compared two DOACs, edoxaban and apixaban, with warfarin and evaluated the incidence of VTE recurrence and bleeding in a period of 3 months. The recurrence was diagnosed based on computed tomography or echography findings. Results: The number of patients treated with edoxaban, apixaban, and warfarin was 47, 31, and 30, respectively. In the warfarin group, the mean international normalized ratio of prothrombin time (2SD) after 3 months was 2.11 (0.42). There was no incidence of major bleeding. Non-major bleeding occurred in 17%, 10%, and 27% of the patients treated with edoxaban, apixaban, and warfarin, respectively (edoxaban vs. warfarin, risk ratio [RR]: 0.64, 95% confidence interval [CI]: 0.27–1.52; apixaban vs. warfarin, RR: 0.38, 95% CI: 0.11–1.28). All bleeding episodes occurred in 30%, 26%, 57% of patients treated with edoxaban, apixaban, and warfarin, respectively (edoxaban vs. warfarin, RR: 0.53, 95% CI: 0.31–0.90; apixaban vs. warfarin, RR: 0.46, 95% CI: 0.23–0.89). Recurrent VTE in edoxaban, apixaban, and warfarin groups occurred in 8%, 3%, and 16% of the patients, respectively (edoxaban vs. warfarin, RR: 0.52, 95% CI: 0.18–2.18; apixaban vs. warfarin, RR: 0.22, 95% CI: 0.03–1.80). Fisher’s exact test was used for statistical analysis. Conclusion: Our study suggests that the DOAC groups are relatively at a lower risk of VTE recurrence, non-major bleeding, as well as all bleeding episodes, as compared with the warfarin group. Therefore, DOAC might be useful in the treatment of VTE in Japanese patients with advanced cancer.

Bradycardia or asystole during epileptic seizure are referred to as ictal bradycardia syndrome. Ictal asystole is very rare, and there is no report about ictal bradycardia syndrome caused by brain metastases. A 62-year old man was diagnosed as having lung cancer and had multiple brain metastases. The patient had no history of epilepsy and syncope. The patient developed cardiac asystole with sinus arrest for up to 16 seconds. The bradycardia was associated with other signs and symptoms, including abdominal pain, nausea, low blood pressure, sinus arrest, decreased level of consciousness, and staring at a single point. Electroencephalograms showed multiple sharp waves. Repeated seizures, ictal asystole, and coexisting symptoms disappeared after improved treatment of brain metastases by radiation therapy. Therefore, a diagnosis of ictal asystole caused by brain metastases was made. There is no recommended treatment for ictal bradycardia syndrome. However, in the case of ictal bradycardia syndrome caused by brain metastases, treatment of the metastatic tumor might be useful. When patients with cancer present with syncope or sick sinus syndrome, we should consider the possibility of cardiac arrest caused by an epileptic seizure.