Effectiveness and Safety of Anticoagulants Among Patients with Venous Thromboembolism and Active Cancer Who Also Had Prior Bleed or Prior Renal Disease

Abstract PURPOSE: Patients with active cancer and venous thromboembolism (VTE) have elevated risk of major bleeding (MB) and recurrent VTE (rVTE). The risk is even higher within those with a prior bleeding event or renal disease. There is a need to understand the risk of MB and rVTE of commonly used anticoagulants among these high-risk patients. METHODS: VTE patients with active cancer and treated with apixaban, warfarin or low molecular weight heparin (LMWH) within 30-days of VTE were identified from 5 claims databases in the United States. Inverse probability of treatment weighting (IPTW) was used to balance patient characteristics. Post-IPTW population was stratified by prior bleed or renal disease status. Cox proportional hazards models were used to evaluate interactions of treatment with prior bleed or renal disease and risk of rVTE and MB,withp-value <0.1 as significant. RESULTS: 30,586 VTE cancer patients met all study criteria: 35.0% had prior bleed and 29.0% had renal disease. Use of apixaban, warfarin or LMWH was similar regardless of prior bleed and renal disease status. Patients with prior bleed or renal disease had a higher incidence of MB vs those without the condition respectively. Generally, no significant interactions were observed between treatment of apixaban, warfarin or LMWH with prior bleed or with renal disease on rVTE and MB (p for interaction >0.1). CONCLUSION: Incidence of MB was higher among those with prior bleed or renal disease. Effects of treatment with apixaban, warfarin, or LMWH were generally consistent regardless of prior bleed or renal disease status.