Oral Xa inhibitors prevent recurrent venous thromboembolism in cancer patients
Oral factor Xa inhibitors may be used as potential substitutes for warfarin and low molecular weight heparin for the prevention of recurrent thromboembolism in oncology patients, suggests a recent study. However, randomized controlled trials are warranted to confirm these results.
A total of 127 patients with venous thromboembolism were recruited, of whom 48 received rivaroxaban or apixaban, 23 received enoxaparin, and 56 received warfarin. Lung (21 percent), colorectal (14 percent) and breast (14 percent) were the three most common cancer diagnoses.
At 3 months, no difference was observed between the rivaroxaban/apixaban (0 percent), warfarin (3.6 percent) and the enoxaparin cohorts (4.4 percent; p=0.8319). Only one patient in the enoxaparin arm (4.2 percent) had a major bleeding at 3 months.
Moreover, mortality was 0 percent, 3.6 percent and 17.4 percent in the rivaroxaban/apixaban, warfarin and enoxaparin cohorts, respectively, at 3 months.
In another study, Xing and colleagues found that rivaroxaban was on a par with enoxaparin in terms of safety and efficacy for the prevention of recurrent venous thromboembolism in patients with malignancy, indicating rivaroxaban as a potential option for cancer patients with venous thromboembolism. [Medicine (Baltimore) 2018;97:e11384]
In this study, the authors used retrospectively obtained data to compare the recurrent venous thromboembolism incidence in oncology patients taking rivaroxaban/apixaban, enoxaparin or warfarin with at least 3 months of follow-up. Inclusion criteria for patients were as follows: active cancer, venous thromboembolism, and taking warfarin, enoxaparin or rivaroxaban/apixaban.
The first episode of recurrent venous thromboembolism at 3 months was the primary endpoint, while the secondary endpoints included recurrent venous thromboembolism after 6 months, major bleeding and mortality.