ArticleResearch and practice in thrombosis and haemostasis2026
Venous thromboembolism and bleeding in advanced melanoma: a propensity-matched cohort analysis comparing first-line immunotherapy and targeted therapy.
Article in Research and practice in thrombosis and haemostasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Venous thromboembolism (VTE) is a leading cause of morbidity in cancer. Immune checkpoint inhibitors and BRAF/MEK-targeted therapy (BRAF/MEKi) are competing first-line options for advanced melanoma, but their comparative thrombotic and bleeding risks remain poorly characterized. Objectives: To compare VTE and bleeding outcomes between first-line ipilimumab/nivolumab (Ipi/Nivo) and BRAF/MEKi in advanced melanoma. Methods: We conducted a retrospective cohort study using the TriNetX federated electronic health record network. Adults with advanced melanoma initiating Ipi/Nivo or BRAF/MEKi were matched 1:1 by propensity score matching. The primary outcome was composite VTE (pulmonary embolism or deep vein thrombosis) at 6 months; secondary outcomes included bleeding events and all-cause mortality. Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional hazards models. Results: After 1:1 matching, 1043 patients per group were included, with well-balanced covariates. Ipi/Nivo was associated with significantly higher 6-month composite VTE (7.0% vs 4.1%; HR, 1.76; 95% CI, 1.19-2.61; Conclusion: First-line Ipi/Nivo appears to be associated with a higher VTE risk compared with BRAF/MEKi in advanced melanoma, without a concomitant increase in bleeding. These hypothesis-generating findings support prospective evaluation of thromboprophylaxis strategies in Ipi/Nivo-treated patients.
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