The Efficacy and Safety of Rivaroxaban and Dalteparin in the Treatment of Cancer Associated Venous Thrombosis

Abstract

Venous thromboembolism (VTE) is a complication of malignancy that is associated with significant mortality. The CLOT trial showed superiority of dalteparin in comparison to warfarin in preventing VTE recurrence. Rivaroxaban has been approved for treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE). In the absence of large randomized trials in the oncology population, the efficacy and safety of rivaroxaban for the treatment of VTE in cancer patients needs to be assessed. A single-center retrospective chart review was conducted to assess the efficacy and safety of rivaroxaban compared with dalteparin in cancer-associated thrombosis. Out of 671 patients identified, 286 patients (107 in the rivaroxaban group and 179 in the dalteparin group) were eligible for analysis. The rivaroxaban group had a rate of VTE recurrence at 6 months of 4.9 versus 11.1% with dalteparin ( = 0.252). The incidence of recurrent DVT at 6 months was lower in patients treated with rivaroxaban (0%) compared with dalteparin (8.2%) at 6 months ( = 0.025). Incidence of recurrent PE in the rivaroxaban group (5%) versus dalteparin group (3.1%) at 6 months was not statistically significant ( = 0.675). No significant difference was identified between the rivaroxaban group and dalteparin group in the rate of major bleeding (2.8 vs. 1.1%, respectively). Rivaroxaban was comparable to dalteparin in prevention of VTE recurrence while having no significant differences with major or minor bleeding.

Comparative Analysis of Enoxaparin versus Rivaroxaban in the Treatment of Cancer Associated Venous Thromboembolism: Experience from a Tertiary Care Cancer Centre

“…On analyzing our data we found out that 50.6% of our population indication for anticoagulation was PE while it was only 29.7% in Chaudhury et al and 39% in Young et al; explaining that our patient population was more at risk at baseline. 17 We also noted that our study had larger percentage of gastric (7.3% Vs 3%) and cervical cancer (6.6% Vs 3%); which studies have shown to also cause a higher rate of VTE recurrence. 18 We also separately analyzed the demographic details of each one of the 6 recurrent DVT patients in rivaroxaban arm and found that 4 of 6 had gastric or pancreatic cancer, low albumin, BMI less than 22 and shared co-morbid (Diabetes, Hypertension and Coronary Artery Disease).…”

Comparative Analysis of Enoxaparin versus Rivaroxaban in the Treatment of Cancer Associated Venous Thromboembolism: Experience from a Tertiary Care Cancer Centre

“…explaining that our patient population was more at risk at baseline. 17 We also noted that our study had larger percentage of gastric (7.3% Vs 3%) and cervical cancer (6.6% Vs 3%); which studies have shown to also cause a higher rate of VTE recurrence. 18 We also separately analyzed the demographic details of each one of the 6 recurrent DVT patients in rivaroxaban arm and found that 4 of 6 had gastric or pancreatic cancer, low albumin, BMI less than 22 and shared co-morbid (Diabetes, Hypertension and Coronary Artery Disease).…”

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

“…It was noted that while recurrent VTE estimate in enoxaparin arm was comparable with previous RCTs (HOKUSAI-VTE, HOKUSAI-VTE CANCER and SELECT D); there was higher recurrent VTE estimate in rivaroxaban arm when compared to current data. On analyzing our data we found out that 50.6% of our population indication for anticoagulation was PE while it was only 29.7% in Chaudhury et al and 39% in Young et al; explaining that our patient population was more at risk at baseline [16]. We also noted that our study had larger percentage of gastric (7.3% Vs 3%) and cervical cancer (6.6% Vs 3%); which studies have shown to also cause a higher rate of VTE recurrence [17].…”