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Isabelle Mahé: Frailty Does Not Mean Less Anticoagulation
Isabelle Mahé /LinkedIn
May 26, 2026, 13:21

Isabelle Mahé: Frailty Does Not Mean Less Anticoagulation

Isabelle Mahé, Head of Internal Medicine at the Louis Mourier Hospital, APHP at Paris Cité University, shared a post on LinkedIn about several recent articles she and her colleagues co-authored, published in Blood Advances, adding:

”In clinical practice, clinicians are often more concerned about bleeding risk in CAT patients presenting with frailty markers.

However, whether the risk of recurrent VTE and the risk of bleeding during anticoagulant therapy are actually higher in frail CAT patients remains poorly assessed.

This meta-analysis including Individual Patient Data (N equals 1413) from four prospective studies of CAT patients treated with standard full-dose tinzaparin (LMWH), with follow-up up to six months, showed that:

First, VTE recurrence risk, unlike bleeding risk, varied according to tumor site and frailty markers including age greater than or equal to 75 years, CrCl less than 50 mL/min, body weight less than or equal to 50 kg, and ECOG greater than or equal to 2.

Second, compared with non-frail patients, frail CAT patients experienced a higher risk of recurrent VTE without an increased risk of major bleeding.

Third, as frailty factors accumulated, the risk of recurrent VTE increased, whereas the risk of major bleeding did not.

Key messages from this analysis:

These findings refine the clinical understanding that cancer type and frailty, often perceived as markers of bleeding risk, may primarily identify patients at higher risk of recurrent VTE rather than bleeding when treated with full-dose LMWH.

Frailty alone should not be considered a contraindication to anticoagulation, even when bleeding risk factors are present.

Importantly, these results do not support routine LMWH full-dose reduction in frail CAT patients.”

Title 1: LMWH dose reduction in CAT: not so fast!

Authors: Abdelrahman Noureldin, Marc Carrier

Isabelle Mahé: Frailty Does Not Mean Less Anticoagulation

Title 2: Complications in patients with cancer-associated thrombosis on tinzaparin by cancer site and frailty: a pooled analysis

Authors: Isabelle Mahé, Céline Chapelle, Philippe Girard, Luis Jara-Palomares, Agnes Y. Y. Lee, Olivier Sanchez, Guy Meyer, Patrick Mismetti, Silvy Laporte

Isabelle Mahé: Frailty Does Not Mean Less Anticoagulation

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Abdelrahman Noureldin Agnes Y. Y. Lee Celine Chapelle Guy Meyer Health Hematology Hemostasis News Hemostasis Today Isabelle Mahé Luis Jara-Palomares Marc Carrier Medicine Olivier Sanchez Patrick Mismetti Philippe Girard Silvy Laporte
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