The risk of recurrent VTE and major bleeding in a commercially‐insured population of cancer patients treated with anticoagulation

Khorana, Alok A.; McCrae, Keith R.; Milentijevic, Dejan; McCormick, Nora; Laliberté, François; Crivera, Concetta; Lefèbvre, Patrick; Lejeune, Dominique; Rozjabek, Heather; Schein, Jeff; Streiff, Michael B.

doi:10.1002/ajh.25361

Cited by 11 publications

(12 citation statements)

References 7 publications

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“…For instance, VTE recurrence rates were lower for rivaroxaban users than for LMWH users at 6 months (13.2% vs 17.1%; p ¼ 0.06) and 12 months (16.5% vs 22.2%; p ¼ 0.03), while major bleeding rates were similar between the cohorts in our previous analysis 11 . Similarly, in our realworld analysis of a younger population of cancer patients, those who initiated LMWH had a 17% higher risk of recurrent VTE compared to rivaroxaban, but a similar risk of major bleeding 18 .…”

Section: Discussionmentioning

confidence: 57%

Healthcare resource utilization and costs associated with venous thromboembolism in cancer patients treated with anticoagulants

Streiff

Milentijevic

McCrae

et al. 2019

Journal of Medical Economics

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Objective: The standard of care for cancer-related venous thromboembolism (VTE) has been low molecular weight heparin (LMWH), but oral anticoagulants are also widely prescribed. This study compared VTE-related healthcare resource utilization and costs of cancer patients treated with anticoagulants. Methods: Claims data from Humana Database (January 1, 2013-May 31, 2015) were analyzed. Based on the first anticoagulant received, patients were classified into LMWH, warfarin, or rivaroxaban cohorts. Characteristics were evaluated during the 6 months pre-index date (i.e. the first VTE); VTErelated resource utilization and costs were evaluated during follow-up. Cohorts were compared using rate ratios, and p-values and 95% confidence intervals were calculated. Healthcare costs were evaluated per-patient-per-year (PPPY) and compared using mean cost differences. Results: A total of 2,428 patients (LMWH: n ¼ 660; warfarin: n ¼ 1,061; rivaroxaban: n ¼ 707) were included. Compared to patients treated with LMWH, patients treated with rivaroxaban had significantly fewer VTE-related hospitalizations, hospitalization days, and emergency room and outpatient visits, resulting in an increase of $12,000 VTE-related healthcare costs PPPY with LMWH vs rivaroxaban. Patients treated with rivaroxaban had significantly lower VTE-related resource utilization compared to patients treated with warfarin; however, VTE-related costs were similar between cohorts. The higher drug costs

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Section: Discussionmentioning

confidence: 57%

Healthcare resource utilization and costs associated with venous thromboembolism in cancer patients treated with anticoagulants

Streiff

Milentijevic

McCrae

et al. 2019

Journal of Medical Economics

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“…These outcomes were also confirmed by the US claims database analysis, which concluded that patients with newly diagnosed cancer, treated with rivaroxaban for VTE, presented a lower recurrent VTE rate compared to LMWHs, while the bleeding rate was comparable between groups during the initial 6 months [ 23 , 24 ]. Both apixaban and rivaroxaban, when used in daily clinical practice, presented encouraging results in terms of VTE recurrence and mortality compared to LMWHs [ 25 , 26 ]. However, the bleeding event rate was higher in the DOAC group [ 25 , 26 ].…”

Section: Real-world Data On Cat Patientsmentioning

confidence: 99%

“…Both apixaban and rivaroxaban, when used in daily clinical practice, presented encouraging results in terms of VTE recurrence and mortality compared to LMWHs [ 25 , 26 ]. However, the bleeding event rate was higher in the DOAC group [ 25 , 26 ].…”

Section: Real-world Data On Cat Patientsmentioning

confidence: 99%

The Role of Direct Oral Anticoagulants in Cancer-Associated Thrombosis According to the Current Literature

Nana

Dakis

Peroulis³

et al. 2021

Medicina

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Venous thromboembolism (VTE) is a common complication among patients suffering from malignancies, leading to an increased mortality rate. Novel randomized trials have added valuable information regarding cancer-associated thrombosis (CAT) management using direct oral anticoagulants (DOACs). The aim of this study is to present an overview of the current literature and recommendations in CAT treatment. A few randomized control trials (RCTs) have been integrated suggesting that DOACs may be effectively applied in CAT patients compared to low molecular weight heparins (LMWHs) with a decreased mortality and VTE recurrence rate. However, the risk of bleeding is higher, especially in patients with gastrointestinal malignancies. Real-world data are in accordance with these RCT findings, while in the currently available recommendations, DOACs are suggested as a reliable alternative to LMWH during the initial, long-term, and extended phase of treatment. Data retrieved from the current literature, including RCTs and “real-world” studies, aim to clarify the role of DOACs in CAT management, by highlighting their benefits and remarking upon the potential adverse outcomes. Current recommendations suggest the use of DOACs in well-selected patients with an increasing level of evidence through years.

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“…Real‐world evidence for DOACs in the treatment of CAT provides additional insights into their use and management, as well as effectiveness, safety, and patient‐reported outcomes associated with use. To date, most of the evidence has been limited to studies of rivaroxaban, whereas real‐world evidence for apixaban in CAT is limited and for dabigatran and edoxaban is currently lacking. When interpreting such data, it is important to note that observational studies are often limited to highly selected and/or small populations of patients with CAT, and that database analyses are limited by retrospective data collection with the possibility of incomplete/missing data.…”

Section: Evidence Base For the Use Of Rivaroxaban In Catmentioning

confidence: 99%

Cancer‐associated venous thromboembolism: Treatment and prevention with rivaroxaban

Bauersachs¹,

Khorana

Lee

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Cancer‐associated venous thromboembolism (VTE) is a frequent, potentially life‐threatening event that complicates cancer management. Anticoagulants are the cornerstone of therapy for the treatment and prevention of cancer‐associated thrombosis (CAT); factor Xa–inhibiting direct oral anticoagulants (DOACs; apixaban, edoxaban, and rivaroxaban), which have long been recommended for the treatment of VTE in patients without cancer, have been investigated in this setting. The first randomized comparisons of DOACs against low‐molecular‐weight heparin for the treatment of CAT indicated that DOACs are efficacious in this setting, with findings reflected in recent updates to published guidance on CAT treatment. However, the higher risk of bleeding events (particularly in the gastrointestinal tract) with DOACs highlights the need for appropriate patient selection. Further insights will be gained from additional studies that are ongoing or awaiting publication. The efficacy and safety of DOAC thromboprophylaxis in ambulatory patients with cancer at a high risk of VTE have also been assessed in placebo‐controlled randomized controlled trials of apixaban and rivaroxaban. Both studies showed efficacy benefits with DOACs, but both studies also showed a nonsignificant increase in major bleeding events while on treatment. This review summarizes the evidence base for rivaroxaban use in CAT, the patient profile potentially most suited to DOAC use, and ongoing controversies under investigation. We also describe ongoing studies from the CALLISTO (Cancer Associated thrombosis—expLoring soLutions for patients through Treatment and Prevention with RivarOxaban) program, which comprises several randomized clinical trials and real‐world evidence studies, including investigator‐initiated research.

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The risk of recurrent VTE and major bleeding in a commercially‐insured population of cancer patients treated with anticoagulation

Cited by 11 publications

References 7 publications

Healthcare resource utilization and costs associated with venous thromboembolism in cancer patients treated with anticoagulants

Healthcare resource utilization and costs associated with venous thromboembolism in cancer patients treated with anticoagulants

The Role of Direct Oral Anticoagulants in Cancer-Associated Thrombosis According to the Current Literature

Cancer‐associated venous thromboembolism: Treatment and prevention with rivaroxaban

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