Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?

Abstract

BackgroundVenous thromboembolic events (VTEs) are common and potentially fatal complications in cancer patients, and they are responsible for the second most common cause of death. Low molecular weight heparin (LMWH) is the gold-standard treatment, but the costs involved limit its use, especially in developing countries. Recently, the oral anticoagulant rivaroxaban, which directly inhibits factor Xa, was approved for VTE treatment.MethodsWe conducted a retrospective analysis from January 2009 to February 2014 with patients who had cancer and VTE who were receiving rivaroxaban. We compared the efficacy, safety, and cost of rivaroxaban and low molecular weight heparin (LMWH) alone or followed by vitamin K antagonists.ResultsForty-one patients were identified, with a median age of 62.5 years. The most frequent tumor histology was adenocarcinoma (78%), which was most often found in the colon (26.8%). Most participants had advanced disease and an implanted central venous catheter. Patients’ VTE risk-assessment scores were low (12.5%), intermediate (50%), and high (35.5%). Pulmonary thromboembolism was reported in 41.4% of patients, but inferior limb thrombosis was reported only in 14.6%; 43.9% of patients received enoxaparin before starting rivaroxaban. Rivaroxaban was used for a median time of 5.5 months. Nonmajor bleeding was reported in 12.2% of patients, and rethrombosis was reported in 12.2%. In our study, rivaroxaban was as safe and effective as enoxaparin/vitamin K antagonists (P = .54 and P = .25, respectively) or LMWH (P = .46 and P = .29, respectively).ConclusionAlthough our study was a retrospective analysis, our results suggest that in this cohort of oncologic patients, rivaroxaban was safe and effective. Its oral route and lower cost make it an attractive alternative to LMWH, improving management of patients with cancer in low-income countries. Additional studies are necessary to confirm our data.

Effectiveness and safety of anticoagulants for the treatment of venous thromboembolism in patients with cancer

“…However, several small studies corroborate the perceived benefits of rivaroxaban over LMWHs in patients with cancer. A retrospective analysis of electronic medical records for cancer patients with VTE reported that rivaroxaban had similar safety (absence of bleeding) and efficacy (rethrombosis) when compared to a LMWH plus warfarin ( P = .54 and P = .25, respectively) or to LMWH alone ( P = .46 and P = .29, respectively) . A separate prospective cohort study assessed rivaroxaban in 200 patients with cancer‐associated thrombosis and reported 6‐month cumulative incidence rates of 4.4% for new and recurrent VTEs and 2.2% for major bleeding .…”

Rivaroxaban versus Low-Molecular-Weight Heparin for Venous Thromboembolism in Gastrointestinal and Pancreatobiliary Cancer

“…These studies demonstrated that rivaroxaban was not inferior to LMWH in terms of recurrence, bleeding incidence, or mortality. However, patients with GI tract cancer accounted for only 25.4%–60% of patients in these studies 13151740. Therefore, these results cannot be generalized to the GI tract cancer population.…”

Systematic Review and Meta‐Analysis of Real‐World Studies Evaluating Rivaroxaban for Cancer‐Associated Venous Thrombosis

“…The inclusion and exclusion of citations/articles identified through the systematic literature search are illustrated in Figure . A total of six studies evaluating rivaroxaban for the treatment of CAT and published between 2016 and 2017 were included in the analysis (Table ) . Of the six studies, three were prospective (one multicenter) and three were retrospective (one used administrative claims data).…”

“…A total of six studies evaluating rivaroxaban for the treatment of CAT and published between 2016 and 2017 were included in the analysis (Table 1). [16][17][18][19][20][21] Of the six studies, three were prospective (one multicenter) and three were retrospective (one used administrative claims data). Individual study sample sizes ranged from 41 to 949 patients.…”