Is Rivaroxaban Effective in Patients with Cancer and Venous Thromboembolism?

July 29, 2016

Is Rivaroxaban Effective in Patients with Cancer and Venous Thromboembolism?

  1. Joel M. Gore, MD

Prospective data from a single-center registry show promise for the direct oral anticoagulant in this clinical context.

  1. Joel M. Gore, MD

Low-molecular-weight heparin (LMWH) is the guideline-recommended anticoagulation strategy for patients with cancer and venous thromboembolism (VTE), as warfarin is not as effective in this population. Given the burden of subcutaneous LMWH injections for patients undergoing cancer treatment, Mayo Clinic researchers prospectively followed 296 consecutive patients who received the direct oral anticoagulant rivaroxaban for VTE (deep venous thrombosis or pulmonary embolism): 118 (40%) with active cancer and 178 controls without cancer. The three most common cancer locations were genitourinary (24%), gastrointestinal (20%), and lung (13%).

Compared with the control group, the cancer group was significantly older and more likely to have pulmonary embolism. During a mean follow-up of 1.4 years, VTE recurred in 3.3% of cancer patients and 2.8% of controls (a nonsignificant difference). A higher rate of major bleeding in cancer than noncancer patients approached but did not reach statistical significance.

Comment

These prospective registry data support the use of rivaroxaban in cancer patients who have associated VTE. Patients with cancer and VTE who wish to avoid subcutaneous LMWH injections should be informed, before choosing rivaroxaban, that it is not yet approved for this indication but that some data support its use. Future head-to-head comparisons between direct oral anticoagulants and LMWH in this population may make them a more widely acceptable option.

Editor Disclosures at Time of Publication

  • Disclosures for Joel M. Gore, MD at time of publication Grant / Research support NIH–National Heart, Lung, and Blood Institute

Citation(s):

Reader Comments (1)

James Dale

Are not the mechanisms of action of the two drugs the same, the inhibition of Factor X activation? Not surprising that rivaroxaban was effective.

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