Comparative analysis of enoxaparin versus rivaroxaban in the treatment of cancer associated venous thromboembolism: experience from a tertiary care cancer centre

Abstract

Background: Venous Thromboembolism (VTE) in cancer patients is associated with increased mortality and morbidity. While newer data on use of direct oral anticoagulants (DOACs) in treating cancer associated thrombosis (CAT) is promising; its data is still few and inconsistent across literature. We designed the study to assess if rivaroxaban would be an appealing alternate choice to treat CAT. Methods: We conducted a retrospective study to evaluate the efficacy and safety profile of rivaroxaban versus enoxaparin in cancer patients after developing a symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE). Baseline patient characteristics and laboratory values were assessed in each arm. Primary efficacy outcome was measured by radiographically confirmed VTE recurrence at different intervals. Primary safety outcome was measured by presence of major and minor bleeding using the ISTH scale. Results: Our study recruited 150 cancer patients with radiologically confirmed DVT and PE; 80 patients were evaluated in enoxaparin arm and 70 patients in rivaroxaban arm. Our results showed that there was no statistically significant difference between the incidence of VTE recurrence at 6 months between the enoxaparin and rivaroxaban arm (10% vs 14.2%, p = 0.42). Historically significant risk factors for VTE in cancer patients such as high platelet count, high leukocyte count, low hemoglobin level, high risk gastrointestinal, genitourinary and lung cancers were not found to be significantly associated with the risk of VTE recurrence. Primary safety outcome analysis also showed no statistically significant difference in major (11.2% vs 11.4%) and minor (15% vs 10%) bleeding between enoxaparin versus rivaroxaban arm respectively (p = 0.65). Conclusion: We conclude that there was no significant difference seen between the efficacy and safety profile of enoxaparin and rivaroxaban in our cancer patient population.

Efficacy and Safety of Rivaroxaban Versus Enoxaparin in Prevention of Recurrence of Venous Thrombo-Embolism Events in Cancer Patients: A Meta-Analysis

“…19 of the remaining articles were then assessed by two independent reviewers (AR and AA) and 11 were excluded as they did not fit our inclusion criteria. Hence, we included 8 studies, 6 of which were retrospective cohort studies 7 , 8 , 15 , 17 – 19 while the remaining 2 were randomised controlled trials. 20 , 21 The articles we included were published between 2014 and 2022.…”

“…The bulk of the included studies were observational in nature, which imposes some constraints, and this is a crucial factor to consider. 18 , 21 Because observational studies rely on already-collected data, selection bias and confounding variables may have an impact on the findings. Therefore, it is important to interpret these results cautiously.…”

Effectiveness and safety of continuous low-molecular-weight heparin versus switching to direct oral anticoagulants in cancer-associated venous thrombosis

“…Increased bleeding risk is the main concern when deciding whether to initiate/extend anticoagulation therapy for patients with CAT, especially in Asian populations that are at higher risk of bleeding with DOACs compared to other populations 22 , 23 . Data addressing the bleeding risk associated with LMWH and DOACs lacks consensus and remains controversial 14 , 17 , 19 , 21 . To date, there are no cohort studies comparing the risk of ICH between DOACs and LMWH, although ICH is the most serious major bleeding type side-effect that threatens life span and is associated with a heavier health management burden than non-ICH major bleeding 24 , 25 .…”

Comparison of the Efficacy and Safety of Rivaroxaban and Low Molecular Heparin in Preventing Venous Thromboembolism in Inpatient Cancer Patients

“…27 It is plausible that the enhanced antithrombotic effect of rivaroxaban is associated with greater coagulation perturbation and a tendency to cause more bleeding than low-molecular heparin, which acts indirectly on factor X. 28 Chemotherapy is a risk factor for developing blood clots in oncology patients. 29 The risk of thrombosis may vary with the times of chemotherapy.…”

“…27 It is plausible that the enhanced antithrombotic effect of rivaroxaban is associated with greater coagulation perturbation and a tendency to cause more bleeding than low-molecular heparin, which acts indirectly on factor X. 28…”