Most Read Articles
Jairia Dela Cruz, 3 days ago
Use of mirabegron in the treatment of men with overactive bladder (OAB) appears to effectively alleviate urgency and storage symptoms, but not reduce the frequency of micturition episodes, according to data from the MIRACLE study.
5 days ago
Drinking coffee confers benefits for recurrence of hepatocellular carcinoma (HCC) and survival following orthotopic liver transplantation, a study has found.
6 days ago
A recent study has shown that the short-term efficacy of tenofovir disoproxil fumarate (TDF) is superior to entecavir (ETV) for the treatment of acute-on-chronic-liver failure (ACLF) due to reactivation of chronic hepatitis B (CHB).
Stephen Padilla, 14 Mar 2019
Long-term use of systemic hormone therapy may increase the risk of Alzheimer’s disease in postmenopausal women, which is not associated with progestogen type or age at initiation of said therapy, according to a Finnish study. On the other hand, use of vaginal oestradiol does not appear to increase such risk.

Apixaban trumps standard treatment in preventing cancer-associated VTE recurrence

Pearl Toh
07 Dec 2018

Apixaban slashes the risk of recurrent venous thromboembolism (VTE) by 90 percent in cancer patients compared with the low-molecular-weight heparin (LMWH) dalteparin, with no increase in major bleeding risk, according to the ADAM VTE study presented at ASH 2018.

“Nearly one in five patients with cancer will develop a clot in the veins … Clotting events can be deadly, with pulmonary embolism being the second most common cause of death in [patients with] cancer,” said Dr Robert McBane from the Mayo Clinic in Rochester, Minnesota, US.

The current guideline-recommended treatment for cancer-associated VTE is LMWH, but LMWH injections are expensive and can cause bruising and pain at the injection site, said McBane. “Patients [with cancer] may experience low platelet counts and be at risk for a clotting disorder called heparin-induced thrombocytopenia.” Also, kidney injury induced by cancer therapy can further limit the use of LMWH.  

Compared with the LMWH dalteparin, apixaban significantly reduced the risk of recurrent VTE in cancer patients by 90.1 percent (hazard ratio [HR], 0.099; p=0.03), with VTE recurrence observed in 0.7 percent of apixaban-treated patients vs 6.3 percent in the dalteparin group. [ASH 2018, abstract 421]

Major bleeding rates were comparable between the apixaban and dalteparin groups (0 percent vs 1.4 percent; p=0.14), indicating that apixaban is safe. Major plus clinically relevant nonmajor bleeds also occurred at similar rates in both groups (6.2 percent vs 6.3 percent; p=0.88).

There were no significant differences in mortality rates at 6 months between the two groups (HR, 1.40; p=0.31).

Based on monthly quality-of-life surveys, patients showed that they preferred apixaban over dalteparin when considering burden of delivery, concerns for excess bruising, irritation, stress, and overall satisfaction with anticoagulants (p<0.05).

“Apixaban was well tolerated with superior patient satisfaction and significantly fewer study drug discontinuations compared with dalteparin,” said McBane, who noted that more patients in the dalteparin group discontinued treatment compared with the apixaban group (15 percent vs 4 percent; p=0.0012). “These data support the use of apixaban for the acute treatment of cancer-associated VTE.”

The multicentre, open-label trial randomized 287 patients (mean age, 64 years) with cancer in a 1:1 ratio to receive apixaban twice daily (10 mg for 7 days followed by 5 mg dose) or subcutaneous dalteparin (200 IU/kg for 1 month and subsequently 150 IU/kg once daily) for 6 months. About two-third of the patients (65.5 percent) had metastatic disease, with lung, pancreas, colorectal, and breast cancers being the four most prevalent cancer types.

“As a class, [direct oral anticoagulants] have a number of advantages, including oral delivery, lack of interactions with foods or other medications, and the lack of a need for monitoring drug levels,” said McBane.

“We are hopeful that this medication will also improve medication compliance in patients [with cancer] requiring blood thinner therapy,” he added.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Jairia Dela Cruz, 3 days ago
Use of mirabegron in the treatment of men with overactive bladder (OAB) appears to effectively alleviate urgency and storage symptoms, but not reduce the frequency of micturition episodes, according to data from the MIRACLE study.
5 days ago
Drinking coffee confers benefits for recurrence of hepatocellular carcinoma (HCC) and survival following orthotopic liver transplantation, a study has found.
6 days ago
A recent study has shown that the short-term efficacy of tenofovir disoproxil fumarate (TDF) is superior to entecavir (ETV) for the treatment of acute-on-chronic-liver failure (ACLF) due to reactivation of chronic hepatitis B (CHB).
Stephen Padilla, 14 Mar 2019
Long-term use of systemic hormone therapy may increase the risk of Alzheimer’s disease in postmenopausal women, which is not associated with progestogen type or age at initiation of said therapy, according to a Finnish study. On the other hand, use of vaginal oestradiol does not appear to increase such risk.