Comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus conventional anticoagulation for the treatment of cancer-related venous thromboembolism: A retrospective analysis

Ross, Jeremy A.; Miller, M.M.; Rojas‐Hernandez, Cristhiam M.

doi:10.1016/j.thromres.2016.12.016

Cited by 40 publications

(34 citation statements)

References 12 publications

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“…These studies also suggest that the decision to use DOACs may also have been driven in part by demographics of the select patients (advanced age, living conditions) and their unwillingness to be adhere to an injectable agent. Prior real-world studies [8][9][10][11] have evaluated DOACs (mostly rivaroxaban) or compared them to LMWHs in patients with CAT and found results generally consistent with the 2 RCTs. These studies, however, frequently included luminal gastrointestinal and/or genitourinary cancers (comprising up to one-third of a study population), had a small DOAC-treated sample size, and/or used heterogeneous (or unclear) definitions of active cancer 8,10,11 that are inconsistent with current guidance.…”

Section: Discussionmentioning

confidence: 73%

“…Observational studies evaluating DOACs for CAT treatment have been published, [8][9][10][11] but these studies were single arm, 8,9 evaluated cancer subtypes not recommended for DOAC treatment (eg, gastrointestinal and genitourinary), 9,10 were of limited sample size, 8,9,11 and/or used heterogeneous definitions of active cancer. 8,10 We sought to evaluate the effectiveness and safety of rivaroxaban vs LMWH for CAT treatment in select patients with active cancers that did not include luminal gastrointestinal or genitourinary malignancies.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and safety of rivaroxaban compared with low-molecular-weight heparin in cancer-associated thromboembolism

et al. 2020

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Guidelines provide differing recommendations regarding direct-acting oral anticoagulants vs low-molecular-weight heparin (LMWH) for treatment of cancer-associated thrombosis (CAT). This study was undertaken to evaluate the effectiveness and safety of rivaroxaban vs LMWH for treatment of CAT. Using US Surveillance, Epidemiology and End Results-Medicare–linked data from 2013 through 2016, we evaluated adults with active breast, lung, ovarian, or pancreatic cancer, who were admitted to the hospital or treated in the emergency department for CAT and were prescribed rivaroxaban or LMWH for outpatient anticoagulation. Patients with luminal gastrointestinal or genitourinary cancers were excluded. Rivaroxaban and LMWH users were 1:1 propensity score matched. Outcomes included the composite of recurrent thrombosis or major bleeding, each outcome separately, and mortality at 6 months, using an intent-to-treat approach. On-treatment analysis after 12 months was also performed. Proportional hazards models for the subdistribution of competing risk were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). We included 529 rivaroxaban- and 529 LMWH-treated patients with CAT. Rivaroxaban was not associated with differences in risk of the composite outcome (HR, 0.71; 95% CI, 0.41-1.22), major bleeding (HR, 1.01; 95% CI, 0.50-2.01), or mortality (HR, 0.87; 95% CI, 0.70-1.07) vs LMWH, but it reduced recurrent thrombosis (HR, 0.37; 95% CI, 0.15-0.95). On-treatment analysis at 12 months showed similar results. Rivaroxaban may be a reasonable alternative to LMWH for patients with CAT without gastrointestinal or genitourinary cancer.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of rivaroxaban compared with low-molecular-weight heparin in cancer-associated thromboembolism

et al. 2020

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“…A retrospective study using the electronic medical records of adult patients with cancer-related VTE reported similar risks of recurrent VTE and MB among patients who initiated DOACs versus LMWH. 43 Another retrospective study conducted in a clinical setting that compared apixaban, enoxaparin, and rivaroxaban among patients with cancerassociated VTE reported that the risk of recurrent VTE and MB was similar across apixaban, enoxaparin, and rivaroxaban. 44 Additionally, rivaroxaban was associated with an increased risk of CRNM bleeding compared with apixaban and enoxaparin.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Apixaban, Low-Molecular-Weight Heparin, and Warfarin among Venous Thromboembolism Patients with Active Cancer: A U.S. Claims Data Analysis

et al. 2020

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Background This study primarily evaluates the risk of recurrent venous thromboembolism (VTE) and major bleeding (MB) among patients with VTE and active cancer prescribed apixaban, low-molecular-weight heparin (LMWH), or warfarin, with claims data. Methods Four U.S. commercial insurance claims databases were used to identify patients with VTE and active cancer who initiated apixaban, LMWH, or warfarin within 30 days following the first VTE event. Stabilized inverse-probability treatment weighting (IPTW) was used to balance treatment cohorts. Cox proportional hazard models were used to evaluate risk of recurrent VTE and MB. Results All eligibility criteria were fulfilled by 3,393 apixaban, 6,108 LMWH, and 4,585 warfarin patients. After IPTW, all patient characteristics were balanced. When the follow-up was censored at 6 months, apixaban patients had a lower risk of recurrent VTE (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.47–0.81) and MB (HR: 0.63; 95% CI: 0.47–0.86) versus LMWH. Apixaban patients had a lower risk of recurrent VTE (HR: 0.68; 95% CI: 0.52–0.90) and similar risk of MB (HR: 0.73; 95% CI: 0.53–1.00) versus warfarin. Warfarin patients had a similar risk of recurrent VTE (HR: 0.91; 95% CI: 0.72–1.15) and MB (HR: 0.87; 95% CI: 0.68–1.12) versus LMWH. The trends were similar for the entire follow-up; however, apixaban patients had a lower risk of MB versus warfarin patients. Conclusion Patients with VTE and active cancer who initiated apixaban had a lower risk of recurrent VTE and MB compared with LMWH patients. Apixaban patients also had a lower risk of recurrent VTE compared with warfarin patients.

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“…34 In comparison to LMWH, DOACs have shown a similar rate of bleeding in a large, retrospective analysis (13 vs. 11%; p ¼ 0.746). 35 The anticoagulation management of GI-cancer associated VTE is even more challenging when patients are thrombocytopenic, which is relatively common when patients are treated with chemotherapy. 36 Patients with thrombocytopenia are more prone to bleeding, and the anticoagulation regimen needs to be dose-adjusted and closely monitored.…”

Section: Management Anticoagulationmentioning

confidence: 99%

Gastrointestinal Malignancies and Venous Thromboembolic Disease: Clinical Significance and Endovascular Interventions

Partovi

Gadani

et al. 2020

Digestive Disease Interventions

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Gastrointestinal malignancy encompasses a wide range of disease processes. Its incidence and mortality rate rank among the highest of all cancers. Venous thromboembolic disease is a common complication of gastrointestinal malignancy. Anticoagulation remains the first-line therapy. However, for patients who cannot tolerate or have failed anticoagulation, inferior vena cava (IVC) filter placement may be an option. Furthermore, to improve symptom resolution and reduce the severity of postthrombotic syndrome, catheter-directed thrombolysis (CDT) may be an option. Recent randomized trials including the ATTRACT (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) trial have shed new light on the efficacy and safety of CDT and related methods. Overall, the decision to proceed with IVC filter placement or CDT must be individualized.

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Comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus conventional anticoagulation for the treatment of cancer-related venous thromboembolism: A retrospective analysis

Cited by 40 publications

References 12 publications

Effectiveness and safety of rivaroxaban compared with low-molecular-weight heparin in cancer-associated thromboembolism

Effectiveness and safety of rivaroxaban compared with low-molecular-weight heparin in cancer-associated thromboembolism

Effectiveness and Safety of Apixaban, Low-Molecular-Weight Heparin, and Warfarin among Venous Thromboembolism Patients with Active Cancer: A U.S. Claims Data Analysis

Gastrointestinal Malignancies and Venous Thromboembolic Disease: Clinical Significance and Endovascular Interventions

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