Recurrence of malignancy-associated venous thromboembolism among patients treated with rivaroxaban compared to enoxaparin

Abstract

Purpose Although low-molecular-weight heparin (LMWH) remains the standard of care, factor Xa inhibitors such as rivaroxaban may serve as an alternative treatment for venous thromboembolism (VTE) in patients with active malignancy. The purpose of the analysis was to evaluate outcomes of VTE management in cancer patients treated with rivaroxaban compared to enoxaparin. Methods This single-center retrospective analysis was conducted on patients with malignancy-associated VTE initiated on treatment with either rivaroxaban or enoxaparin. The primary endpoint was the incidence of recurrent VTE. Secondary outcomes included a comparison in rates of bleeding, mean duration of treatment, and mean time to recurrence of VTE. Results A total of 45 patients were included in each group. The incidence of recurrent VTE was 8.9% in the rivaroxaban group versus 13.3% in the enoxaparin group ( p = 0.53). There were no statistically significant differences in the secondary outcomes with the exception of longer mean duration of treatment in the rivaroxaban group compared to the enoxaparin group (169 vs. 110 days, respectively; p = 0.04). Conclusions This study provides important preliminary information regarding the efficacy and safety of rivaroxaban for treatment of VTE in cancer patients. Although LMWH should remain the standard of care, these results provide initial reassurance that rivaroxaban serves as a viable alternative in the event that injectable anticoagulation is not an acceptable approach to VTE management.

Risk of recurrence and bleeding in patients with cancer‐associated venous thromboembolism treated with rivaroxaban: A nationwide cohort study

“…The risk of recurrent VTE ranged from 0% to 13.2% with the most extreme estimates observed in studies including very few patients or not accounting competing risk of death leading to overestimation of event rates; in the majority of studies recurrence risk was approximately 3%‐5%. The risk of major bleeding ranged from 0% to 17%, again with the most extreme estimates obtained in studies with very few patients, for example the estimate of a 17% risk of major bleeding originated from studies with 18 and 48 patients, respectively . Six studies provided estimates of clinically relevant nonmajor bleeding, which ranged from 1.2% to 12.2% (5 events) (Table ; Table ).…”

Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty

“…Rivaroxaban was found to be roughly inferior to enoxaparin in the study. In another study conducted by alexander et al, primary outcome occurred in 7.7% patients in the dabigatran group and 8.8% patients in the enoxaparin group with an absolute risk difference of 1.1% (95% CI, -3.8% to 1.6%) [22] . Furthermore, meta-analysis by Gomez-Outes et al, reported risk of symptomatic VTE with dabigatran (relative risk 0.71, CI 0.23 to 2.12) is similar and comparable to enoxaparin [23] .…”

Rivaroxaban versus enoxaparin for the prevention of recurrent venous thromboembolism in patients with cancer

“…According to our predefined criteria, a total of 4 articles and 667 patients were included in the final analysis [ 8 , 9 , 11 , 12 ] (Flow Diagram). The majority of included articles (3 out of 4) were published in 2017.…”