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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
The standard of care for the treatment of cancer-related venous thromboembolism (VTE) is a low molecular weight heparin (LMWH) formulation. The recent development of direct oral anticoagulants (DOACs) and their approval for the treatment of VTE has resulted in several new options for treatment. If e...
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| Published in: | Thrombosis research 2017-02, Vol.150, p.86-89 |
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| creator | Ross, Jeremy A. Miller, Marilyn M. Rojas Hernandez, Cristhiam M. |
| description | The standard of care for the treatment of cancer-related venous thromboembolism (VTE) is a low molecular weight heparin (LMWH) formulation. The recent development of direct oral anticoagulants (DOACs) and their approval for the treatment of VTE has resulted in several new options for treatment. If equivalent to LMWH in terms of safety and effectiveness, the use of DOACs in the treatment of cancer-related VTE would reduce the risk of VTE recurrence while potentially improving the quality of life of many cancer patients.
We performed a retrospective analysis of adult patients with cancer-related VTE treated in our benign hematology clinic. Among the 153 patients included in our final analysis, 123 (80%) were treated with LMWH and 30 (20%) were treated with DOACs. Patients had 36 different histological types of cancer. The primary outcome was the rate of recurrence of VTE evaluated at 6 and 12months after the initiation of anticoagulation. Secondary outcomes were the rate of anticoagulant-associated clinically relevant bleeding and event-free survival for VTE recurrence.
In comparing the 2 treatment groups, there was no statistically significant difference in the cumulative rates of VTE recurrence at 6 and 12months or in the rates of major or non-major bleeding at both 6 and 12months. The median VTE recurrence-free survival rates were not reached and they were not statistically different.
DOACs appear to be as safe and effective as conventional therapy for the treatment of cancer-related VTE. Results of ongoing randomized clinical studies may provide definitive evidence and clarify the role of the DOACs in the setting of malignancy. |
| doi_str_mv | 10.1016/j.thromres.2016.12.016 |
| format | article |
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We performed a retrospective analysis of adult patients with cancer-related VTE treated in our benign hematology clinic. Among the 153 patients included in our final analysis, 123 (80%) were treated with LMWH and 30 (20%) were treated with DOACs. Patients had 36 different histological types of cancer. The primary outcome was the rate of recurrence of VTE evaluated at 6 and 12months after the initiation of anticoagulation. Secondary outcomes were the rate of anticoagulant-associated clinically relevant bleeding and event-free survival for VTE recurrence.
In comparing the 2 treatment groups, there was no statistically significant difference in the cumulative rates of VTE recurrence at 6 and 12months or in the rates of major or non-major bleeding at both 6 and 12months. The median VTE recurrence-free survival rates were not reached and they were not statistically different.
DOACs appear to be as safe and effective as conventional therapy for the treatment of cancer-related VTE. Results of ongoing randomized clinical studies may provide definitive evidence and clarify the role of the DOACs in the setting of malignancy.</description><identifier>ISSN: 0049-3848</identifier><identifier>EISSN: 1879-2472</identifier><identifier>DOI: 10.1016/j.thromres.2016.12.016</identifier><identifier>PMID: 28064037</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>Administration, Oral ; Aged ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Anticoagulants - therapeutic use ; Disease-Free Survival ; Female ; Hemorrhage - chemically induced ; Heparin, Low-Molecular-Weight - administration & dosage ; Heparin, Low-Molecular-Weight - adverse effects ; Heparin, Low-Molecular-Weight - therapeutic use ; Humans ; Male ; Middle Aged ; Neoplasms - complications ; Recurrence ; Retrospective Studies ; Venous Thromboembolism - drug therapy ; Venous Thromboembolism - etiology</subject><ispartof>Thrombosis research, 2017-02, Vol.150, p.86-89</ispartof><rights>2016 Elsevier Ltd</rights><rights>Copyright © 2016 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-2f3d2224e4b9c8ec75f8a6491276cfe929ac857bb541b1c62699613180d6c12f3</citedby><cites>FETCH-LOGICAL-c434t-2f3d2224e4b9c8ec75f8a6491276cfe929ac857bb541b1c62699613180d6c12f3</cites><orcidid>0000-0001-7299-599X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28064037$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ross, Jeremy A.</creatorcontrib><creatorcontrib>Miller, Marilyn M.</creatorcontrib><creatorcontrib>Rojas Hernandez, Cristhiam M.</creatorcontrib><title>Comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus conventional anticoagulation for the treatment of cancer-related venous thromboembolism: A retrospective analysis</title><title>Thrombosis research</title><addtitle>Thromb Res</addtitle><description>The standard of care for the treatment of cancer-related venous thromboembolism (VTE) is a low molecular weight heparin (LMWH) formulation. The recent development of direct oral anticoagulants (DOACs) and their approval for the treatment of VTE has resulted in several new options for treatment. If equivalent to LMWH in terms of safety and effectiveness, the use of DOACs in the treatment of cancer-related VTE would reduce the risk of VTE recurrence while potentially improving the quality of life of many cancer patients.
We performed a retrospective analysis of adult patients with cancer-related VTE treated in our benign hematology clinic. Among the 153 patients included in our final analysis, 123 (80%) were treated with LMWH and 30 (20%) were treated with DOACs. Patients had 36 different histological types of cancer. The primary outcome was the rate of recurrence of VTE evaluated at 6 and 12months after the initiation of anticoagulation. Secondary outcomes were the rate of anticoagulant-associated clinically relevant bleeding and event-free survival for VTE recurrence.
In comparing the 2 treatment groups, there was no statistically significant difference in the cumulative rates of VTE recurrence at 6 and 12months or in the rates of major or non-major bleeding at both 6 and 12months. The median VTE recurrence-free survival rates were not reached and they were not statistically different.
DOACs appear to be as safe and effective as conventional therapy for the treatment of cancer-related VTE. Results of ongoing randomized clinical studies may provide definitive evidence and clarify the role of the DOACs in the setting of malignancy.</description><subject>Administration, Oral</subject><subject>Aged</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulants - therapeutic use</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Hemorrhage - chemically induced</subject><subject>Heparin, Low-Molecular-Weight - administration & dosage</subject><subject>Heparin, Low-Molecular-Weight - adverse effects</subject><subject>Heparin, Low-Molecular-Weight - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasms - complications</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Venous Thromboembolism - drug therapy</subject><subject>Venous Thromboembolism - etiology</subject><issn>0049-3848</issn><issn>1879-2472</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNqFUU1v1DAQjRCIbgt_ofKxHBJsx3FiTqyWT6lSL3C2HGdMvUrixfautL-vf6wT0iJx4mDNjOfNm49XFNeMVowy-X5f5fsYpgip4hhXjFdoXhQb1rWq5KLlL4sNpUKVdSe6i-IypT2lrGWqeV1c8I5KQet2UzzswnQw0WR_AgLOgV28GVIiZh5IMg7ymQRHBh8xR0I0I2ayt8H8Oo7oJXLz6W67S-_ICWI6JmLDjAzZh_lf6PJDXIgk3wPJEUyeELZwWzNbiGUEBMGAPHNAnj8L9gHwjT5NH8iWRMgxpMM6JHKb8Zx8elO8cmZM8PbJXhU_v3z-sftW3t59_b7b3pZW1CKX3NUD51yA6JXtwLaN64wUivFWWgeKK2O7pu37RrCeWcmlUpLVrKODtAyrr4qblfcQw-8jpKwnnyyMeAXAgTXrGtnJpm0VQuUKtThviuD0IfrJxLNmVC8C6r1-FlAvAmrGNRosvH7qcewnGP6WPSuGgI8rAHDTk4eok_WA91sF0kPw_-vxCAA6tis</recordid><startdate>201702</startdate><enddate>201702</enddate><creator>Ross, Jeremy A.</creator><creator>Miller, Marilyn M.</creator><creator>Rojas Hernandez, Cristhiam M.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7299-599X</orcidid></search><sort><creationdate>201702</creationdate><title>Comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus conventional anticoagulation for the treatment of cancer-related venous thromboembolism: A retrospective analysis</title><author>Ross, Jeremy A. ; Miller, Marilyn M. ; Rojas Hernandez, Cristhiam M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c434t-2f3d2224e4b9c8ec75f8a6491276cfe929ac857bb541b1c62699613180d6c12f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Administration, Oral</topic><topic>Aged</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>Anticoagulants - therapeutic use</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Hemorrhage - chemically induced</topic><topic>Heparin, Low-Molecular-Weight - administration & dosage</topic><topic>Heparin, Low-Molecular-Weight - adverse effects</topic><topic>Heparin, Low-Molecular-Weight - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasms - complications</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Venous Thromboembolism - drug therapy</topic><topic>Venous Thromboembolism - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ross, Jeremy A.</creatorcontrib><creatorcontrib>Miller, Marilyn M.</creatorcontrib><creatorcontrib>Rojas Hernandez, Cristhiam M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Thrombosis research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ross, Jeremy A.</au><au>Miller, Marilyn M.</au><au>Rojas Hernandez, Cristhiam M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus conventional anticoagulation for the treatment of cancer-related venous thromboembolism: A retrospective analysis</atitle><jtitle>Thrombosis research</jtitle><addtitle>Thromb Res</addtitle><date>2017-02</date><risdate>2017</risdate><volume>150</volume><spage>86</spage><epage>89</epage><pages>86-89</pages><issn>0049-3848</issn><eissn>1879-2472</eissn><notes>SourceType-Other Sources-1</notes><notes>content type line 63</notes><notes>ObjectType-Feature-2</notes><notes>ObjectType-Correspondence-1</notes><notes>ObjectType-Article-3</notes><abstract>The standard of care for the treatment of cancer-related venous thromboembolism (VTE) is a low molecular weight heparin (LMWH) formulation. The recent development of direct oral anticoagulants (DOACs) and their approval for the treatment of VTE has resulted in several new options for treatment. If equivalent to LMWH in terms of safety and effectiveness, the use of DOACs in the treatment of cancer-related VTE would reduce the risk of VTE recurrence while potentially improving the quality of life of many cancer patients.
We performed a retrospective analysis of adult patients with cancer-related VTE treated in our benign hematology clinic. Among the 153 patients included in our final analysis, 123 (80%) were treated with LMWH and 30 (20%) were treated with DOACs. Patients had 36 different histological types of cancer. The primary outcome was the rate of recurrence of VTE evaluated at 6 and 12months after the initiation of anticoagulation. Secondary outcomes were the rate of anticoagulant-associated clinically relevant bleeding and event-free survival for VTE recurrence.
In comparing the 2 treatment groups, there was no statistically significant difference in the cumulative rates of VTE recurrence at 6 and 12months or in the rates of major or non-major bleeding at both 6 and 12months. The median VTE recurrence-free survival rates were not reached and they were not statistically different.
DOACs appear to be as safe and effective as conventional therapy for the treatment of cancer-related VTE. Results of ongoing randomized clinical studies may provide definitive evidence and clarify the role of the DOACs in the setting of malignancy.</abstract><cop>United States</cop><pub>Elsevier Ltd</pub><pmid>28064037</pmid><doi>10.1016/j.thromres.2016.12.016</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0001-7299-599X</orcidid></addata></record> |
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| subjects | Administration, Oral Aged Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulants - therapeutic use Disease-Free Survival Female Hemorrhage - chemically induced Heparin, Low-Molecular-Weight - administration & dosage Heparin, Low-Molecular-Weight - adverse effects Heparin, Low-Molecular-Weight - therapeutic use Humans Male Middle Aged Neoplasms - complications Recurrence Retrospective Studies Venous Thromboembolism - drug therapy Venous Thromboembolism - etiology |
| title | Comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus conventional anticoagulation for the treatment of cancer-related venous thromboembolism: A retrospective analysis |
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