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DOAC therapy prevents VTE recurrence, bleeding in patients with cancer

30 Sep 2018

Use of direct-acting oral anticoagulants (DOACs) in patients with cancer and venous thromboembolism (VTE) results in only two episodes of clinically significant bleeding and no episodes of recurrent VTE, according to the results of a single-centre, retrospective, observational study.

Of the 37 patients included, 12 were diagnosed with pulmonary embolism (PE), 21 with deep vein thrombosis (DVT), three with both DVT and PE, and one with DVT and superficial vein thrombosis. The most commonly used DOAC was apixaban (n=27).

None of the patients had a recurrent DVT or PE at 6 months. In addition, only two patients experienced adverse effects during treatment.

A previous study involving patients with active cancer and VTE showed rivaroxaban to have similar efficacy compared to enoxaparin and a vitamin K antagonist for the prevention of VTE recurrence and the reduction of major bleeding events. A head-to-head comparison of rivaroxaban with long-term low-molecular-weight heparin is needed in cancer patients. [Lancet Haematol 2014;1:e37-46]

To assess the use of DOAC in patients with cancer and VTE, the present study identified patients by a retrospective data extraction of those treated at Ochsner Medical Centre from 1 January 2013 through 31 December 2015.

Eligibility criteria for the review included age ≥18 years, a confirmed diagnosis of VTE and active or history of cancer, and treatment with dabigatran, apixaban, rivaroxaban or edoxaban for at least 6 months. The primary endpoints were the rate of VTE recurrence and incidence of bleeding at 6 months.

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Men who undergo flexible cystoscopy, particularly with a longer dwell time, may benefit from intraurethral lidocaine as it provides significant pain reduction, suggest the results of a meta-analysis. Evidence is lacking for other tested interventions.
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