Real-world evaluation of therapeutic anticoagulation for cancer-associated thromboembolism: A retrospective analysis

BackgroundThrombosis is the second leading cause of death in cancer patients and treatment for thrombosis and prevention for secondary prophylaxis is anticoagulation. Low-molecular-weight heparin (LMWH) is more effective than vitamin K antagonists for the treatment of cancer-associated thromboembolism (CAT). Direct oral anticoagulants (DOACs) are non-inferior to dalteparin in treating CAT with similar major bleeding risks. Major guidelines recommend DOACs for CAT; however, data comparing individual DOACs to enoxaparin is lacking. The purpose of this study is to evaluate the efficacy and safety of DOACs compared to LMWH for CAT.MethodsA multi-site retrospective review was conducted in adult cancer patients with a CAT history who received either a DOAC (apixaban or rivaroxaban) or LMWH (enoxaparin). Primary efficacy and safety endpoints were recurrent thromboembolism and major bleeding occurrences. Secondary endpoints included time to subsequent CAT occurrence, time to first bleed event post initial CAT, and incidence of clinically relevant non-major and minor bleeding.ResultsA total of 102 patients were included in the study. There was no significant difference among the groups with respect to time to subsequent CAT (p = 0.5625). However, patients who received apixaban and rivaroxaban had a 2.39 times and 3.26 times higher risk of subsequent CAT respectively compared to those who received enoxaparin. Major bleeding rates were also not statistically significant (p = 0.465), despite enoxaparin having the highest rate at 8.8% and no rivaroxaban patients experiencing major bleeding.ConclusionNo differences were observed between rivaroxaban, apixaban, and enoxaparin in rates of recurrent venous thromboembolism (VTE) and bleeding.