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Edoxaban as effective as dalteparin for cancer-related venous thromboembolism

23 Jan 2018

In cancer patients with acute symptomatic or incidental venous thromboembolism, oral edoxaban is noninferior to subcutaneous dalteparin in terms of recurrent venous thromboembolism or major bleeding, according to a study.

A total of 1,046 patients were randomized to receive either low-molecular-weight heparin for 5 days followed by oral edoxaban at 60 mg once daily (edoxaban arm; n=522; mean age 64.3 years; 53.1 percent male) or subcutaneous dalteparin at 200 IU per kilogram of body weight once daily for 1 month followed by dalteparin at a 150 IU per kilogram once daily (dalteparin group; n=524; mean age 63.7 years; 50.2 percent male). Treatment lasted for at least 6 months and up to 12 months.

At 12 months following randomization, the primary outcome of rate of recurrent venous thromboembolism or major bleeding was lower in the edoxaban vs dalteparin arm (12.8 percent vs 13.5 percent; hazard ratio, 0.97; 95 percent CI, 0.70–1.36; p=0.006 for noninferiority; p=0.87 for superiority).

When analysed separately, recurrent venous thromboembolism occurred with less frequency in the edoxaban arm (7.9 percent vs 11.3 percent; difference in risk, −3.4 percentage points; −7.0 to 0.2). In contrast, major bleeding was more common among edoxaban-treated patients than among those given dalteparin (6.9 percent vs 4.0 percent; difference in risk, 2.9 percentage points; 0.1‒5.6).

The rate of adverse events, with the most common being progression of neoplasm and pneumonia, was similar between the two treatment arms.

A common complication of cancer and its treatment, venous thromboembolism is challenging to manage, with cancer patients at greater risk of recurrent thrombosis and bleeding compared with those without cancer. The said complications are important because they contribute to mortality and morbidity, as well as interfere with cancer treatment and increase the risk of hospitalization.

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Stephen Padilla, Yesterday
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