Novel oral anticoagulants significantly reduced total bleeding events (13.0% vs 25.0%) and pulmonary embolism (2.5% vs 9.0%) compared to traditional anticoagulants in critically ill patients undergoing radiotherapy.
RCT (n=400)
Randomly assigned
No
Do novel anticoagulants (rivaroxaban and apixaban) reduce thromboembolic events and bleeding complications compared to traditional anticoagulants in critically ill patients exposed to radiotherapy?
In critically ill cancer patients undergoing radiotherapy, novel anticoagulants (rivaroxaban and apixaban) may offer a safer and more effective alternative to traditional anticoagulants by reducing both thromboembolic events and bleeding complications.
Absolute Event Rate: 13% vs 25%
p-value: p=0.013
Background: This study investigates the impact of novel anticoagulants on bleeding risk and thrombosis in critically ill patients, with a special focus on those who are exposed to radiation therapy.We compare the safety and efficacy of rivaroxaban and apixaban to traditional anticoagulants to assess their role in radiation-induced coagulopathies.Materials and Methods: A total of 400 critically ill patients requiring anticoagulation were included.Patients were divided into two groups: the experimental group received novel anticoagulants, and the control group received traditional anticoagulants (heparin or low molecular weight heparin).Radiotherapy was administered based on standard protocols to patients with various cancers, including breast, lung, gastrointestinal, and head and neck cancers.Various bleeding and coagulation parameters, including activated partial thromboplastin time (aPTT) and prothrombin time (PT), were measured to assess thrombotic and bleeding risks. Results:The experimental group showed a significant reduction in the incidence of thromboembolic events compared to the control group.The novel anticoagulants demonstrated significantly fewer bleeding complications and a more favorable safety profile.Radiological imaging used to assess pulmonary embolism or deep vein thrombosis also suggested lower follow-up requirements in the experimental group, hinting at the efficiency of novel anticoagulation strategies in reducing the need for radiation-based diagnostics.Conclusion: The use of novel anticoagulants in critically ill patients exposed to radiotherapy appears to effectively balance the anticoagulation benefit with a reduced bleeding risk, offering a potential alternative to traditional therapies.Their ability to manage radiation-induced coagulopathies and reduce complications could enhance the overall care and outcomes of radiation-exposed patients.
Lin et al. (Thu,) conducted a rct in Critically ill patients requiring anticoagulation exposed to radiotherapy (n=400). Novel oral anticoagulants (rivaroxaban or apixaban) vs. Traditional anticoagulants (low molecular weight heparin or unfractionated heparin) was evaluated on Total bleeding events (p=0.013). Novel oral anticoagulants significantly reduced total bleeding events (13.0% vs 25.0%) and pulmonary embolism (2.5% vs 9.0%) compared to traditional anticoagulants in critically ill patients undergoing radiotherapy.