Apixaban to Prevent Venous Thromboembolism in Patients with Cancer

Carrier, Marc; Abou-Nassar, Karim; Mallick, Ranjeeta; Tagalakis, Vicky; Shivakumar, S; Schattner, Ariah; Kuruvilla, Philip; Hill, Danny; Spadafora, Silvana; Marquis, Katerine; Trinkaus, Martina; Tomiak, Anna; Lee, Agnes Y.Y.; Gross, Peter L.; Lazo‐Langner, Alejandro; El-Maraghi, Robert H.; Goss, Greg G.; Gal, Grégoire Le; Stewart, David B.; Ramsay, Timothy; Rodger, Marc; Witham, Debra; Wells, Philip S.; Investigators, Avert

doi:10.1056/nejmoa1814468

Cited by 642 publications

(631 citation statements)

References 22 publications

Supporting

Mentioning

586

Contrasting

Unclassified

Order By: Relevance

“…Extended low molecular weight heparin has been shown in two randomized, placebo controlled trials in solid tumors to reduce VTE during chemotherapy by 50% 85 86. The recently published randomized, placebo-controlled AVERT trial of prophylactic apixaban during solid tumor chemotherapy demonstrated a 60% reduction in VTE in those randomized to apixaban 87. However, VTE guidelines specific to gynecologic cancer are lacking.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

Int J Gynecol Cancer

481

344

View full text Add to dashboard Cite

BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

show abstract

Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

Int J Gynecol Cancer

481

344

View full text Add to dashboard Cite

show abstract

“…Details regarding the two included RCTs are shown in Table . The AVERT trial (Canada) enrolled adult patients with active cancer who were initiating new chemotherapy and had a modified Khorana score of 2 or higher . The mean age was 61 and 42% were males.…”

Section: Resultsmentioning

confidence: 99%

Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta‐analysis

Kuderer

García

et al. 2019

Journal of Thrombosis and Haemostasis

Self Cite

View full text Add to dashboard Cite

Background It is unclear if direct oral anticoagulant (DOAC) is efficacious and safe for prophylaxis of venous thromboembolism (VTE) in ambulatory patients with cancer. Methods We performed a systematic review using EMBASE, MEDLINE, and CENTRAL. Inclusion criteria included adult ambulatory patients with cancer, prophylactic use of DOAC, and randomized controlled trials. Exclusion criteria included pediatric patients, inpatient or postoperative setting, therapeutic indication of DOAC, or non‐phase III randomized controlled trial. Two authors screened/reviewed articles and abstracted the data. Meta‐analysis was performed using random‐effects model. Efficacy outcome included overall and symptomatic VTE incidence during the first 6 months. Safety outcomes included major bleeding and clinically relevant non‐major bleeding (CRNMB) incidence during the on‐treatment period. Subgroup analysis was performed for intermediate‐ and high‐risk Khorana score. Results A total of 202 records were identified and 28 full‐text articles were assessed. Two studies with 1415 participants were included for meta‐analysis. For DOAC vs placebo, the relative risks for overall and symptomatic VTE incidence by 6 months were 0.56 (0.35‐0.89) and 0.58 (0.29‐1.13), respectively. The relative risks for major bleeding and CRNMB while on‐treatment were 1.96 (0.80‐4.82) and 1.28 (0.74‐2.20), respectively. Patients with high‐risk Khorana score (3+) derived the largest absolute risk reduction of VTE. Conclusions Low‐dose DOAC reduces the rate of overall VTE in higher risk cancer patients starting systemic chemotherapy. It may reduce the rate of symptomatic VTE but increase the likelihood of bleeding.

show abstract

“…Over time, VTE risk assessment at baseline may become less relevant for patients, but assessing dynamic risk factors such as hospitalization (demonstrated here), chemotherapy choice, or performance status may become more important. Two randomized trials were recently published using the Khorana score to risk stratify cancer patients for pharmacologic thromboprophylaxis . These trials demonstrated a modest benefit in VTE reduction at the expense of increased bleeding.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for cancer‐associated venous thromboembolism: The venous thromboembolism prevention in the ambulatory cancer clinic (VTE‐PACC) study

Douce

Holmes

Cushman

et al. 2019

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background The Khorana Score is a validated risk score for predicting 6‐month incidence of cancer‐associated venous thromboembolism (CAT) among patients starting chemotherapy. Venous thromboembolism (VTE) risk factors important in the general population, including age, sex, prior VTE, and hospitalization, are not included in this score, their association with VTE in cancer patients is unknown. Objective To examine risk factors for CAT and the impact of incorporating longitudinal hospitalization into risk assessment. Methods Risk factors were recorded among patients starting chemotherapy at a single institution from 2012‐14. Hospitalization and time‐periods after hospitalization were assessed as time‐varying covariates. Logistic regression was used to determine factors related to 6‐month CAT risk (the Khorana Score endpoint). Proportional hazard models were used for risk factor identification throughout the 3‐year observation period. Results Among 1,583 patients starting chemotherapy (mean age 60, 48% male), 187 developed CAT (11.8%) with 129 (69%) cases occurring within 6 months of starting chemotherapy. In the 6‐month analysis, no additional risk factors were associated with CAT. In the 3‐year analysis, male sex (HR 1.57, 95%CI 1.21, 2.07), prior VTE (HR 2.12, 95%CI 1.41, 3.18), and hospitalization (HR 2.69, 95%CI 1.92, 3.75) were associated with increased hazard of CAT, adjusting for risk factors in the Khorana score. Conclusions When time‐to‐event data were incorporated into CAT risk assessment, male sex, prior VTE, and hospitalization were important risk factors. These data highlight the need to consider dynamic methods for assessing VTE risk in cancer patients, with particular attention to the period around hospitalizations.

show abstract

Apixaban to Prevent Venous Thromboembolism in Patients with Cancer

Cited by 642 publications

References 22 publications

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta‐analysis

Risk factors for cancer‐associated venous thromboembolism: The venous thromboembolism prevention in the ambulatory cancer clinic (VTE‐PACC) study

Contact Info

Product

Resources

About